Chimeric antigen receptor T-cell therapy: Challenges and framework of outpatient administration

eJHaem

article

Katie S. Gatwood¹  Bhagirathbhai R. Dholaria²  Mariana Lucena³  Brittney Baer⁴  Bipin N. Savani²  Olalekan O. Oluwole² 

[1] Department of Pharmacy, Vanderbilt University Medical Center;Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center;Medexus Pharmaceuticals, Inc.;Department of Nursing, Clinical Trials Office, Vanderbilt University Medical Center;Division of Hematology-Oncology, Department of Medicine, Tennessee Valley Healthcare System

关键词: chimeric antigen receptor T cell;    leukemia;    lymphoma;    monitoring;    outpatient;    toxicity;   

DOI  :  10.1002/jha2.333

来源: Wiley

【 摘 要 】

Adoptive cellular therapy has made a landmark change within the treatment paradigm of several hematologic malignancies, and novel cellular therapy products, such as chimeric antigen receptor T-cell therapy (CART), have demonstrated impressive efficacy and produced durable responses. However, the CART treatment process is associated with significant toxicities, healthcare resource utilization, and financial burden. Most of these therapies have been administered in the inpatient setting due to their toxicity profile. Improved toxicity management strategies and a better understanding of cellular therapy processes are now established. Therefore, efforts to transition CART to the outpatient setting are warranted with the potential to translate into enhanced patient quality of life and cost savings. A successful launch of outpatient CART requires several components including a multidisciplinary cellular therapy team and an outpatient center with appropriate clinical space and personnel. Telemedicine should be incorporated for closer monitoring. Additionally, clear criteria for admission upon clinical decompensation, a pathway for prompt inpatient transition, and clear toxicity management guidelines should be implemented. Effective education about cellular therapy and toxicity management is imperative, especially for the Emergency Department and Intensive Care Unit teams. Here, we have outlined the various logistical and clinical considerations required for the care of CART patients, which will aid centers to establish an outpatient CART program.

【 授权许可】

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