Coordinated Clinical Care For CAR T Lymphoma Patients a Multidisciplinary Approach

Panelists discuss how community oncologists should introduce CAR T therapy during the first consultation with lymphoma patients to provide reassurance about available treatment options and establish the full treatment pathway.

Panelists discuss how eligibility criteria for CAR T therapy have expanded over time, emphasizing that all patients meeting disease indications should be referred to treatment centers rather than having community oncologists make exclusion decisions.

Panelists discuss how earlier referrals for CAR T therapy led to better outcomes due to healthier T cells, reduced need for bridging therapy, and improved survival benefits demonstrated in clinical trials.

Panelists discuss how community oncologists should navigate referral processes to academic centers and balance CAR T therapy against other emerging treatments like bispecific antibodies based on curative potential.

Panelists discuss how community oncologists can overcome misconceptions about CAR T toxicity by understanding that the therapy has evolved to be safer, with shorter hospital stays and better outcomes.

Panelists discuss how the dissolution of REMS requirements and availability of outpatient CAR T therapy have significantly improved access by reducing monitoring restrictions and caregiver requirements.

Panelists discuss how acute CAR T toxicities follow predictable patterns based on specific products, with cytokine release syndrome typically preceding neurotoxicity and inflammatory markers serving as early indicators.

Panelists discuss how preventive strategies like dexamethasone can reduce high-grade toxicities in high-risk patients while prophylactic tocilizumab is avoided due to increased neurotoxicity risk.

Panelists discuss how community oncologists should manage long-term CAR T complications, including hypogammaglobulinemia, cytopenias, and opportunistic infections while maintaining communication with treating centers.

Panelists discuss how CMV monitoring should be implemented for patients who received extensive corticosteroids and how persistent cytopenias beyond 6 months warrant bone marrow evaluation.

Panelists discuss how the extremely rare risk of T-cell malignancies after CAR T therapy should be contextualized against the certain mortality risk of untreated refractory lymphoma.

Panelists discuss how the timing of community transition depends on ongoing toxicities and patient comfort levels, with continued communication essential for managing lingering effects like cytopenias and autonomic dysfunction.

Panelists discuss how community practices need better systems for disseminating CAR T care guidelines to all team members and clearer vaccination schedules for patients post CAR T.

Panelists discuss how expanding CAR T to more community sites requires adequate volume, intensive care unit support, and subspecialty backup, while recognizing that not every center should administer this therapy.

Panelists discuss how CAR T therapy represents the best curative option for relapsed B-cell lymphoma and how community oncologists must prepare for the inevitable expansion of cellular therapies across multiple disease areas.