Successful Outpatient Administration of Chimeric Antigen Receptor T Cell (CarT) Therapies without Remote Monitoring Device Use in a Non-Academic Medical Center

CarT therapy is an effective therapy for hematologic malignancies and solid tumor. Acute toxicities of CarT therapy, including cytokine release syndrome (CRS) and Immune-effector cell associated neurologic syndrome (ICANS) may necessitate inpatient hospitalization for administration of CarT and subsequent toxicity monitoring and management. However, inpatient administration of CarT may be cost prohibitive for health systems and outpatient CarT administration may improve sustainability of CarT programs. Our center has various monitoring schedules for each CarT product and disease type as described in Table1. We assessed outcomes for patients in our center undergoing outpatient administration separately for four different CarT products (axi-cel, liso-cel, brexu-cel, and ide-cel) and several diagnoses (DLBCL/FL, MZL, MCL, ALL, CLL/SLL, and MM). This is a nonacademic single institution, retrospective analysis of safety and efficacy outcomes of patients undergoing outpatient administration of CarT. All patients undergoing outpatient commercial CarT infusion with at least 30 days post infusion follow up data were eligible. ASTCT grading was used for CRS and ICANS grading. Statistics are descriptive only. 63 patients (pts) underwent outpatient CarT between May 2021 to July 2024 (liso-cel 36pts, bre-cel 6 pts, ide-cel 10 pts, axi-cel 11 pts). Demographics in each CarT product and disease type were described in Table2. Out of 63 pts, 30 pts (48%) did not require hospitalization in Days 0-30. 9 pts (14%) admitted by Day2 (within 72 hours of CarT infusion) and 24 pts (38%) admitted after Day3 of CarT infusion. Only 4pts (6%) had infection in Days0-30. Low grade CRS was observed in 43pts (68%). No grade 3 or higher CRS was noted. Neurotoxicity was observed in 20 pts (grade1/2 15pts 24%, grade3/4 5 pts 8%). CarT related toxicity in Days0-30 in each CarT product and disease type were described in Table3. 45 pts (71%) responded to CarT therapy. OS at 100 days post CarT is 93%. Outcomes in each CarT product and disease type were described in Table4. Outpatient administrations of CarT were conducted successfully at our center. We are recruiting other centers to gather additional data regarding best practices and to study the outcomes for these patients. We expect to help establish the best practices for outpatient CarT in further investigations so that these therapies can be more widely accessible and safe to deliver.