Artificial intelligence-enabled nursing surveillance for pediatric cancer immunotherapy: integrating biomarkers, patient-reported outcomes, and long-term toxicity management.
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Pediatric cancer immunotherapy has expanded from anti-GD2 antibodies and bispecific T-cell engagers to immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy. These treatments can produce rapid, nonlinear, and partially overlapping toxicities, including cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, infection, prolonged cytopenia, B-cell aplasia, and organ-specific immune-related adverse events. Nurses provide the highest-frequency clinical observations across inpatient, ambulatory, and home settings, yet conventional monitoring often fragments laboratory data, vital signs, neurologic findings, caregiver observations, and patient-reported outcomes. Artificial intelligence (AI) offers a means to fuse these longitudinal signals into individualized risk trajectories. The clinically relevant mechanism, however, is not autonomous prediction; it is a nurse-in-the-loop system in which AI improves temporal sensitivity and prioritization, while nurses verify signal quality, interpret age- and development-specific context, reconcile child-caregiver discordance, activate protocol-based escalation, and maintain accountability. This Mini Review examines how biomarkers, continuous physiological monitoring, electronic patient-reported outcomes, and caregiver-reported behavioral changes can support AI-enabled nursing surveillance during acute immunotoxicity and long-term survivorship. We propose a three-layer framework linking immune-toxicity biology, a multimodal digital phenotype, and nursing counter-regulation. We also discuss workflow integration, alert fatigue, model drift, bias, privacy, and the need for prospective pediatric validation. AI should augment not replace specialist pediatric oncology nursing judgment and should be evaluated by whether it improves timely intervention, symptom burden, family experience, and long-term safety.