Management Across Settings: An Ambulatory and Community Perspective for Patients Undergoing CAR T-Cell Therapy in Multiple Care Settings

Alix Beaupierre, BSN, RN, OCN®; Rachel Lundberg, PA-C; Leslie Marrero, BSN, RN, OCN®, BMTCN®; Michael Jain, MD, PhD; Trent Wang, DO, MPH; Maritza C. Alencar, DNP, MBA, APRN-BC, BMTCN®


Background: Many patients are referred to chimeric antigen receptor (CAR) T-cell therapy programs from outside their primary oncology setting and community. Collaboration between the referring and treating providers is required to coordinate safe and effective care.

Objectives: This article presents an overview of key considerations for referring providers and institutions prior to and following CAR T-cell therapy.

Methods: Definitions of the consultation and workup, leukapheresis, bridging, lymphodepleting chemotherapy, infusion and monitoring, and long-term follow-up phases are presented, along with specific considerations for referring centers.

Findings: Although CAR T-cell therapy is limited to select centers, the process of supporting and educating patients and their caregivers requires a partnership between referring and treating providers. As CAR T-cell indications expand, management of patients in diverse settings requires a collaborative and evidence-based approach to support safe and effective care.

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