Key Points
• In patients diagnosed with refractory B-cell hematological malignancies, chimeric antigen receptor (CAR) T-cell therapies that target the CD19 antigen have proven highly effective. CAR T-cell therapies work in patients in whom multiple lines of therapy have failed and a dearth of options remain. A growing interest in administering this therapy in an outpatient setting has developed—a prospect that the authors of this article address.
• “Patient-specific factors must be assessed for inpatient versus outpatient administration,” wrote the authors. “The primary considerations for determining individual patient suitability for outpatient administration are often the probability, severity, and the predicted time to onset (ie, early vs late) of CRS [cytokine release syndrome] and ICANS [immune effector cell-associated neurotoxicity syndrome], as well as the availability of socioeconomic support (ie, assessed willingness, understanding and ability to return to the medical center with concerning signs and symptoms).”
• The authors stressed the importance of communicating the inpatient vs. outpatient financial burden of CAR-T cell therapy with patients and family members. In particular, reimbursement considerations need to be addressed.
• Ultimately, the authors suggested that outpatient CAR-T is feasible and safe when institutions are capable of managing outcomes with established procedures and policies in place. Future research should focus on defining needs and quantifying subsequent hospital readmission metrics following infusion. “For example,” they wrote, “time from onset of symptoms to hospital and/or ICU admission would be beneficial. Identification of reliable predictors, including biomarkers, of severe treatment-associated complications, both general and unique, as well as additional data from outpatient CAR-T cell therapy in the real-world setting, will aid in patient identification, risk reduction, and expanded outpatient administration.”