Implementation of CAR-T cell therapy in outpatient settings: a critical review of current literature regarding health outcomes, benefits, challenges, and future directions.

Abstract

Chimeric Antigen Receptor (CAR) T-cell therapy has transformed the treatment landscape for hematologic malignancies. Although CAR-T cell therapy was traditionally administered in inpatient settings due to concerns related to acute toxicities, there is a growing trend toward outpatient administration. This review looks at the critical aspects of CAR T-cell therapy in outpatient settings, focusing on benefits, feasibility, limitations, and prospects. Implementation of careful selection criteria for outpatient therapy is found to achieve comparable efficacy and safety as in inpatient settings, particularly when supported by robust monitoring and rapid response protocols. Two major potential side effects of CAR-T cell therapy, namely, Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS), which appear to be key concerns related to outpatient administration, are discussed. Outpatient administration significantly lowers healthcare system costs, improves resource allocation, and, more importantly, increases patient psychological well-being. Despite these compelling factors, the outpatient model is not without risks and limitations, particularly necessitating comprehensive support strategies to ensure equitable and timely access and a specialized team of staff and resources for monitoring and timely management of the toxicity of CAR T-cell therapy. Continued development in CAR-T product design and remote monitoring technologies is of crucial importance to further establish and implement outpatient CAR-T therapy as a standard of care, expanding its reach and impact.