By Sara Bondell – February 26, 2024
Multiple myeloma patients receiving CAR T therapy undergo lymphodepleting chemotherapy before being admitted into the hospital for the CAR T infusion. Patients remain in the hospital on average one week to be monitored for cytokine release syndrome (CRS) and other neurotoxicity syndromes that can cause fever, nausea and trouble breathing.
However, not all patients suffer severe side effects and need to be hospitalized. Moffitt Cancer Center launched a study to investigate if commercial ciltacabtagene autoleucel, or cilta-cel, CAR T therapy for multiple myeloma can be given in an outpatient setting.
The study’s results, presented at the 2024 Tandem Meetings, show that the treatment is safe and feasible to be delivered outpatient. Instead of being hospitalized, patients were managed in Moffitt’s outpatient Immune Cell Therapy, or ICE-T, service and admitted only if they were showing signs of CRS or other severe side effects.
Of the 27 patients included in the study, two were never admitted to the hospital. The median hospital stay for those who were admitted was four days, compared to a median stay of 11 days when the treatment was administered for typical planned outpatient to inpatient model.
Taiga Nishihori, MD, Department of Blood and Marrow Transplant and Cellular Immunotherapy
“In general, patients had a much shorter hospital stay and were managed appropriately for CRS,” said presenting author Taiga Nishihori, MD. “We think that most patients in good physical condition can be managed as outpatient until they develop CRS. Moffitt has a unique setup with beds secured for our T-cell patients so they don’t have to go through an usual emergency room route and can be directly admitted to our ICE-T floor if needed.”
In general, patients report preferring to stay at home or in local lodgings instead of the hospital. Prior to the treatment they receive in-depth education on self-monitoring and symptoms to look out for.
Moffitt will continue to treat more multiple myeloma patients with commercial cilta-cel CAR T in an outpatient setting in hopes of growing the infrastructure and one day expanding outpatient treatment to other CAR T products and blood cancer patients.
What is CAR T Therapy?
Chimeric antigen receptor therapy, or CAR T therapy, is an immunological treatment that uses the body’s own immune system to destroy cancerous cells. Normally, a person’s T cells are responsible for detecting noncancerous “intruders,” such as viruses and bacteria. However, by genetically modifying these cells to recognize the unique proteins that are present on the surface of cancer cells, it’s possible to program them to destroy cancerous cells while leaving healthy cells alone.