open access
Outpatient CAR-T therapy
Affiliations- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569 Poznań, Poland
open access
Abstract
Chimeric antigen receptor T (CAR-T) therapy has recently revolutionized the treatment of aggressive lymphomas and acute lymphoblastic leukemia, and will soon do the same for myeloma and other hematological malignancies. Due to the risk of potentially life-threatening complications such as cytokine release syndrome (CRS) and immune effector cell associated neurological syndrome (ICANS), patients have been hospitalized for the time when those symptoms may have occurred. However, due to improved prognostic factors, diagnostics and treatment of CRS and ICANS, it is possible that in the near future certain groups of patients will be treated with CAR as outpatients. That would allow broader access to CAR therapy, lowering overall costs and improving patient quality of life. Patient selection for outpatient CAR treatment is a topic that has been extensively discussed but, even based on the experience we already have, can already be effectively performed. CAR as an outpatient could be particularly useful for younger patients with a low tumor burden who have an educated caregiver and whose CAR center is logistically capable of providing outpatient care.
Abstract
Chimeric antigen receptor T (CAR-T) therapy has recently revolutionized the treatment of aggressive lymphomas and acute lymphoblastic leukemia, and will soon do the same for myeloma and other hematological malignancies. Due to the risk of potentially life-threatening complications such as cytokine release syndrome (CRS) and immune effector cell associated neurological syndrome (ICANS), patients have been hospitalized for the time when those symptoms may have occurred. However, due to improved prognostic factors, diagnostics and treatment of CRS and ICANS, it is possible that in the near future certain groups of patients will be treated with CAR as outpatients. That would allow broader access to CAR therapy, lowering overall costs and improving patient quality of life. Patient selection for outpatient CAR treatment is a topic that has been extensively discussed but, even based on the experience we already have, can already be effectively performed. CAR as an outpatient could be particularly useful for younger patients with a low tumor burden who have an educated caregiver and whose CAR center is logistically capable of providing outpatient care.
Keywords
CAR-T, outpatient, cellular therapy
About this articleTitle
Outpatient CAR-T therapy
Journal
Issue
Article type
Review article
Pages
180-182
Published online
2022-05-25
Page views
2049
Article views/downloads
141
DOI
10.5603/AHP.a2022.0020
Bibliographic record
Acta Haematol Pol 2022;53(3):180-182.
Keywords
CAR-T
outpatient
cellular therapy
Authors
Dominik Dytfeld
Lida Gil
References (10)- Schuster SJ, Tam CS, Borchmann P, et al. JULIET Investigators. Tisagenlecleucel in adult relapsed or refractory diffuse large B-cell lymphoma. N Engl J Med. 2019; 380(1): 45–56.
- Maude SL, Laetsch TW, Buechner J, et al. Tisagenlecleucel in children and young adults with B-cell lymphoblastic leukemia. N Engl J Med. 2018; 378(5): 439–448.
- Locke FL, Ghobadi A, Jacobson CA, et al. Long-term safety and activity of axicabtagene ciloleucel in refractory large B-cell lymphoma (ZUMA-1): a single-arm, multicentre, phase 1-2 trial. Lancet Oncol. 2019; 20(1): 31–42.
- Bachier CR, Godwin J, Andreadis C, et al. Outpatient treatment with lisocabtagene maraleucel (liso-cel) across a variety of clinical sites from three ongoing clinical studies in relapsed/refractory (R/R) large B-cell lymphoma (LBCL). J Clin Oncol . 2020; 38(15_suppl): 8037–8037.
- Dwivedy Nasta S, Namoglu EC, Hughes ME, et al. Hospitalization patterns with commercial CAR T-cell therapy: a single institution experience. Blood. 2019; 134(Suppl_1): 3240.
- Shadman M, Gopal A, Smith S, et al. CD20 targeted CAR-T for high-risk B-cell non-Hodgkin lymphomas. Blood. 2019; 134(Suppl_1): 3235.
- Dytfeld D, Dhakal B, Agha M, et al. Bortezomib, lenalidomide and dexamethasone (VRd) followed by ciltacabtagene autoleucel versus VRD followed by lenalidomide and dexamethasone (Rd) maintenance in patients with newly diagnosed multiple myeloma not intended for transplant: a randomized, phase 3 study (CARTITUDE-5). Blood. 2021; 138(Suppl 1): 1835.
- Hayden PJ, Roddie C, Bader P, et al. Management of adults and children receiving CAR T-cell therapy: 2021 best practice recommendations of the European Society for Blood and Marrow Transplantation (EBMT) and the Joint Accreditation Committee of ISCT and EBMT (JACIE) and the European Haematology Association (EHA). Ann Oncol. 2022; 33(3): 259–275.
- Myers GD, Verneris MR, Goy A, et al. Perspectives on outpatient administration of CAR-T cell therapy in aggressive B-cell lymphoma and acute lymphoblastic leukemia. J Immunother Cancer. 2021; 9(4).
- Carreras E, Dufour C, Mohty M, Kröger N. eds. The EBMT handbook: hematopoietic stem cell transplantation and cellular therapies [Internet]. 7th edition. Springer, Cham 2019.