推进 CAR-T 细胞治疗的可及性：来自社区肿瘤学实践的见解与真实世界经验

We conducted a retrospective review of a community practice-based outpatient CAR T-cell therapy program, independent of academic or hospital affiliation, treating patients with relapsed hematologic malignancies. The implementation process, completed over six months, followed a structured series of steps to ensure safe and effective outpatient administration.

Between April 19, 2022, and December 18, 2024, 41 adult patients received outpatient CAR T-cell therapy. Products administered included liso-cel (n=19), ide-cel (n=12), axi-cel (n=8), and brex-cel (n=2). CRS occurred in 68% of patients, and ICANS in 22%. Hospital admission was required for 49% of patients, with 15% needing ICU care. Clinical remission rates at day 100 and 1 year were consistent with published data for each product. Patients receiving 4-1BB co-stimulatory domain CAR T-cells were observed to have numerically lower hospitalization rates (32%) compared to those receiving CD28-based products (100%). No unexpected safety concerns were observed under home-based monitoring.

This analysis demonstrates that outpatient CAR T-cell therapy can be safely delivered in a community oncology practice setting, offering a viable solution to expand access and reduce geographic barriers. Despite clinical success, payer reluctance remains a significant barrier, highlighting the urgent need for policy reform to enable community-based delivery of advanced therapies.