Establishing a successful outpatient CAR T-Cell program with cilta-cel: real-world experience from an expert roundtable.

Abstract

In less than a decade since their first approval, chimeric antigen receptor T-cell (CAR-T) therapies have moved into earlier lines of therapy, shifting administration from an inpatient to an outpatient setting and increasing patient demand. Several CAR-T outpatient programs have been initiated to meet patient and institution needs, resulting in resource conservation, increased treatment capacity, reduced hospitalization times, and financial advantages. Ciltacabtagene autoleucel (cilta-cel) is uniquely suited for outpatient administration, given its predictably delayed cytokine release syndrome and immune-effector cell-associated neurotoxicity syndrome profile in adult patients with relapsed or refractory multiple myeloma (MM). Given the evolution of MM treatment, the distinct safety profile of cilta-cel, limited hospital capacities, cost considerations, and patient preference, outpatient administration of cilta-cel is becoming a critical part of ensuring increased access to CAR-T therapy in a timely manner to most, if not all, eligible patients. To highlight the practical aspects of cilta-cel outpatient programs and to facilitate the establishment of similar initiatives at other clinics, a group of hematology/oncology specialists with expertise in myeloma and cellular therapies participated in a roundtable discussion. They shared their real-world experiences, provided insights on feasibility, safety, and effectiveness, and identified key success factors to prepare institutions, patients, and caregivers.