What’s the Difference Between Outpatient and Inpatient CAR T-Cell Therapy?

CAR T-cell therapy is a newer form of immunotherapy that can treat some types of blood cancers, such as lymphoma, multiple myeloma, and leukemia. Patients can be treated with this therapy as an inpatient or outpatient, depending on their case and specific needs.

“Historically, we were giving these therapies in the hospital, but what we’ve learned over the last few years is that outpatient therapy is very safe and effective,” says Omar Nadeem, MD, clinical director of Myeloma Immune Effector Cell Therapy Program and of the Center for Early Detection and Interception of Blood Cancers at Dana-Farber.  

All aspects of patient care, from conditioning chemotherapy and infusion of genetically modified CAR T cells to follow-up monitoring, are the same for both outpatients and inpatients.

What determines my ability to receive CAR T-cell therapy as an inpatient or outpatient?  

Once you meet the criteria for CAR T-cell therapy, your physician will determine whether you should receive treatment as an inpatient or outpatient depending on:

• Overall health assessment based on factors like age, other medical conditions, socioeconomic status and physical exams. Patients considered low-risk and more stable are more likely to receive care in an outpatient setting.

• Whether you have a caregiver who can be available at all times (24/7) during and for at least 14 days following CAR T-cell infusion. The commitment of the caregiver is one of the most pivotal roles, since they will be responsible for managing the patient’s care.  

• Whether you can stay in short-term accommodation near your hospital. For example, patients must stay within 30 minutes of Dana-Farber for the length of treatment and for at least 14 days following.
  

What are the benefits of receiving care as an outpatient?  

As an outpatient receiving CAR T-cell therapy, you have the opportunity to:  

• Be surrounded by your loved ones. 

• Have more freedom in your day-to-day life, such as the ability to stay active and eat foods you are accustomed to. 

• Have more privacy.  

• Sleep in a more familiar or comfortable setting such as your own home, if you reside in proximity to Dana-Farber. 

• Receive support from a resource specialist who can help with transportation to/from the hospital and nearby hotel accommodations. Many patients are able to walk to/from the hospital from their hotel. 

The goal is to enable low-risk patients to maintain a comfortable and positive quality of life. 

“We want patients to have an improved quality of life, if that means they are more comfortable outside the hospital with less interruptions overnight and a greater ability to go out into the world,” says Linda Ramsdell, MSN, FNP-BC, OCN, Assistant Program Director of Immune Effector Cellular Therapy at Dana-Farber.  

Outpatients receive the same services as hospitalized patients — education for caregivers on patients’ needs during and after treatment, pharmacy services, social work and financial counseling— in conjunction with pre- and post-treatment. Whether you are an outpatient or inpatient, resources for long-term survivorship care are provided. 

What will my experience as an outpatient be like?  

The treatment process for CAR T-cell therapy is the same for all patients. The location to the hospital is the main difference for inpatient and outpatient patients. Outpatient treatment steps include:  

• Preparative chemotherapy about 3 to 5 days before scheduled infusion.  

• CAR T infusion in the outpatient clinic setting.  

• Daily clinic appointments for about 7 to 10 days after CAR T-cell infusion.  

Following the 7 to 10-day period, based on health status, your physician will approve you to return home if you live within 2 hours of the hospital or require you to stay nearby in short-term accommodations for up to 14 days after CAR T infusion.

Dana-Farber care and resources are available to all patients at all times. Patients or caregivers with concerns can call the direct line to a physician or a clinical social worker or want to learn more to determine if the patient should be admitted for further treatment and monitoring. 

Dana-Farber care and resources are available to all patients at all times. Patients or caregivers with concerns can call the direct line to a physician or clinical social worker or want to learn more to determine if the patient should be admitted for further treatment and monitoring.