Continuous Temperature Monitoring (CTM) for Cytokine Release Syndrome (CRS), an Immune-Related Adverse Event

Background:

• Cellular therapy and cellular engager-based immunotherapy treatments, including but not limited to Chimeric Antigen Receptor (CAR) T-cell and bispecific T-cell engagers (BiTE), have an adverse event profile that often involves Grade >= 3 Cytokine Release Syndrome (CRS).
• As a sequela of activating the immune system to engage their underlying cancer, CRS symptoms can range from grade 1 (e.g., fever amenable to supportive care with antipyretics) to grade 4 (e.g., multiorgan failure requiring hospital admission for advanced vasopressor and ventilator support), even proceeding to death in severe cases.
• The symptoms of CRS can escalate over time, but early detection with accelerated intervention has been shown to avert high-grade CRS and more serious complications.
• A prompt CRS diagnosis shortens the treatment window for targeted interventions. Such as tocilizumab, a monoclonal antibody that blocks the interleukin (IL)-6 receptor, or systemic corticosteroids. Agents that can mitigate CRS from progressing to more severe grades, decrease the need for Intensive Care Unit (ICU) management, and could potentially redefine CRS monitoring using an outpatient management algorithm.
• TempTraq is a Food and Drug Administration (FDA)-cleared continuous temperature monitoring (CTM) wearable patch device. Compared with intermittent temperature monitoring used in Standard of Care (SOC) practice, this CTM approach has been shown to detect fevers earlier by a median of 4.9 hours.
• VitalTraq is a multi-vital, multi-sensor smartphone/Tablet application allowing data collection of blood pressure, heart rate, heart rate variability, and respiration rate using Remote Photoplethysmography technology (rPPG). The VitalTraq application involves a viscerocranial capillary scan, whereby a camera scans the small blood vessels of the face for 30-60 seconds. VitalTraq has not yet been FDA-cleared.

Objective:

-To assess whether continuous observations of fevers with TempTraq versus intermittent fevers monitoring reduce the risk of progression to grade >= 3 cytokine release syndrome (CRS)

Eligibility:

• Age >= 18 years
• Histologically or cytologically proven cancer
• Receiving cellular therapy, cellular engagers, or other novel monotherapy or combination immunotherapy agents associated with a known or anticipated risk profile for grade >= 3 CRS at NIH

Design:

• After enrollment, participants will be randomized to Arm 1 or Arm 2. Participants in Arm 1 will get a non-readable Continuous Temperature Monitoring (CTM) TempTraq wearable device WITH actionable alerts, and participants in Arm 2 will get a non-readable CTM TempTraq wearable device WITHOUT actionable alerts.
• All participants will continue to be monitored for vital signs per the treatment protocols they are enrolled in.
• For the Intervention Arm 1 only, the assigned nurse will receive alerts set for temperature data that reaches and/or exceeds a threshold above 100.4 degrees Fahrenheit on their designated clinic smartphone. With a temperature alert from the device, nursing staff would be expected to reassess the participant and to evaluate vital signs with the Unit s standard device thermometer within one hour of the initial threshold alert.
• Temperature data from the standardized devices and TempTraq will hold equivalent primacy per clinician discretion, as well as activation of the procedures outlined in the participant s primary treatment protocol.
• The post-hoc analysis includes a chart review of medical history and clinical course with adjudication of febrile etiology, either related to CRS alone or likely related to CRS. For the temperature readings obtained from CTM TempTraq and the standard device used in the Clinical Center, the chart review will compare time of fever detection, diagnosis of CRS, initiation of CRS interventions, incidence of CRS complications with use of supportive care, and duration of CRS episode.
• We will also evaluate additional markers predictive of progression to grade >= 3 CRS (e.g., monitoring with VitalTraq, demographics, performance status, treatment history, hematologic biomarkers).

• INCLUSION CRITERIA:
• Age >= 18 years.
• Participants must be enrolled in an active treatment protocol at NIH utilizing cellular therapy, cellular engagers, or other novel monotherapy or combination immunotherapy agents associated with a known or anticipated risk profile for grade >= 3 cytokine release syndrome (CRS) adverse effects.
• Participants must be receiving immunotherapy dose(s) and be admitted to the Clinical Center. Note: Enrollment during the first week of treatment on an active treatment protocol, when CRS risk is highest, is preferable, but starting later during their active treatment course is acceptable.
• Ability of the participant to understand and the willingness to sign a written informed consent document.

Exclusion criteria

• Prior solid organ or stem cell transplantation on active immunosuppression.
• Regimen including antibiotics, for documented active infection within 7 days prior to study enrollment.
• Current syndrome associated with cyclic fevers.
• History of severe drug allergies, including Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS).
• Known current alcohol use disorder or drug use disorder that, in the opinion of the investigator, would interfere with the participant s ability to comply with study procedures or safely participate in the study.