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.

Chimeric antigen receptor (CAR) T-cell therapy has been approved for use in several relapsed/refractory hematologic malignancies and has significantly improved outcomes for these diseases. A number of different CAR T products are now being used in clinical practice and have demonstrated excellent outcomes to those in clinical trials. However, increased real-world use of CAR T therapy has uncovered a number of barriers that can lead to significant delays in treatment. As a result, bridging therapy has become a widely used tool to stabilize or debulk disease between leukapheresis and CAR T cell administration. Here we review the available data regarding bridging therapy, with a focus on patient selection, choice of therapy, timing of therapy, and potential pitfalls.

Since the advent of the first Food and Drug Administration (FDA)-approved chimeric antigen receptor (CAR-T) cell therapy in 2017 foraggressive large B cell lymphoma, the excitement around this nascent,cutting-edge therapy has only continued to grow in the arena of Hematology and Oncology. CAR-T cell therapy involves harnessing a patient’sown or donor immune cells and subsequently engineering these T cellsto recognize specific antigens on tumor cells and in turn causing cancer cell death. The development of this new treatment modality hasbeen a beacon of the direction of where cancer treatment is headedin the future. Leaving behind the diffuse cytotoxic side effects of standard chemotherapy in its path, CAR-T cell therapy has become aneffective and well-tolerated therapeutic option for many patients withrelapsed or refractory hematologic malignancies. However, as experience with CAR-T cell therapy continues to develop and data regarding long-term efficacy and side effects mature, we are learning thatthere is more to learn. Herein this special issue, we discuss what weknow, what the current challenges are, and what we need to learn inthe future regarding this avant-garde therapy that has changed thelandscape for so many with life-threatening hematologic malignancies(Table 1).