Jessdee223

A lot of CAR-T and BMT is being done outpatient with daily follow-ups. my hospital is doing CAR-T for glioblastoma as wall. Really gnarly

And you're welcome!

For standard of care CAR products, grade 2 definitely requires toci, so that required inpatient administration per the REMS program. I just meant that, grade 1 doesn't always require toci. Usually is someone presents with grade 1 within 72 hours of cell infusion, if it's persistent grade 1, or grade 1 in the setting of massive CAR expansion (I once saw someone absolute lymphocyte counts quadruple within 48 hours), that usually calls for toci. the rationale at my facility is, most patients will require an inpatient stay at some point. If you can maximize their time outpatient (home, if appropriate), that improves their quality of life and overall bodes well for their recovery.

Hi there! a lot of car t is done outpatient, at least in my experience in Massachusetts. If you think of the volume of patients receiving treatment and the limited number of inpatient beds, there's no way to accommodate everyone inpatient at the same time. remember, the median CRS onset for cilta-cel is around 7 days. At my facility, the majority of cilta-cel patients get outpatient treatment, follow up with us daily through count recovery, and are told to notify us of any crs. If it's early onset or at least Grade 2, we get them if for toci, dex, anakinra, etc. we have an infusion room that is held in prep for this.