Patients who receive T-cell redirecting therapies are typically hospitalised for several days after treatment to watch for side effects.

Now new research by Fox Chase Cancer Centre physicians shows that these patients can safely be monitored at home.

The study, presented today at the 67th American Society of Haematology (ASH) Annual Meeting and Exposition, showed that a structured outpatient model significantly reduced the number of days patients spent in the hospital, with no negative outcomes.

Fewer Hospital Days, No Safety Compromises

“There are multiple benefits to our approach,” said first author Asya Varshavsky-Yanovsky, MD, PhD, an Associate Professor in the Blood Cancer and Cellular Therapy Institute at Fox Chase.

“These include decreased disruption to the patient’s normal life, reduced exposure to the risks of hospitalisation, optimising the utilisation of inpatient beds, and of course healthcare costs.”

With a growing number of patients benefiting from T-cell redirecting therapies, it’s important to find strategies to treat more patients with existing resources, she added.

Supercharging Patients’ Immune System

T-cell redirecting therapies, including CAR-T and bispecific T cell engagers (BiTEs), are a type of immunotherapy that supercharges the patient’s immune system to fight cancer.

While these therapies have been a game-changing treatment option for patients with blood cancers like lymphoma and multiple myeloma, they can also cause potentially severe side effects triggered by an overactive immune response.

While these therapies were just emerging, inpatient monitoring was appropriate, Varshavsky-Yanovsky said.

Researchers wanted to know if outpatient observation could be done safely now that the therapies’ toxicities are better understood.

Key Findings From the Fox Chase Outpatient Model

• Fox Chase implemented outpatient T-cell redirecting therapy as a pilot programme for the majority of patients with relapsed lymphoma and multiple myeloma.
• The programme significantly reduced hospital admissions for both CAR-T and BiTE patients.
• Patients in the outpatient CAR-T programme saw a reduction in total hospital stay and some of them were able to avoid hospitalisation altogether. More than half of those in the BiTE programme avoided hospitalisation entirely.
• There were no adverse safety events or clinically significant delays in care as a result of the outpatient model.

How Home Monitoring Works

To receive outpatient CAR-T or BiTE therapy, patients are required to have a caregiver who can monitor their condition during the observation period.

They also have to remain within 60 minutes of the cancer centre.

Fox Chase helped arrange housing for patients who lived farther away.

Patients undergo a daily toxicity assessment in the clinic during the monitoring window.

Close communication with patients and caregivers, as well as detailed education about warning signs and symptoms of toxicity, were critical to the programme’s success, Varshavsky-Yanovsky said.

Also critical were availability of an on-call trained cell therapy provider and close multidisciplinary collaboration within the treatment team.

The programme’s simplicity means it could be easily reproduced by other hospitals, she added.

“We designed this programme to work, and we put a lot of thought into making it safe for patients. I’m not surprised it was a success.”

Article: Delivering CAR-T and bites outpatient: A safe and resource-conscious model for T-cell redirecting therapies

Source: Temple University Health System