Additional Resources Needed in the Community Setting to Manage CAR T in Patients With B-Cell Lymphoma

Dr Friedman identifies communication challenges in community settings where care guidelines may not reach all team members involved in patient care. While Dana-Farber provides comprehensive written instructions via email, these may not be prominently placed in electronic medical records or adequately communicated to advanced practice providers covering patients. This creates anxiety among less experienced staff who may encounter patients undergoing CAR T without proper preparation or understanding of management protocols.

He suggests developing supplementary resources such as intranet-based best practices websites or enhanced electronic medical record integration to ensure guidelines remain accessible to all potential caregivers. The challenge involves preventing outdated information while ensuring comprehensive coverage across different communication channels and learning styles within health care teams.

Vaccination timing represents another area of confusion, with Dr Friedman noting insufficient guidance in current discharge instructions. Dr Jacobson clarifies her approach: waiting 12 months for one-time vaccines (RSV, Shingrix, DTAP, pneumonia) due to prolonged immunosuppression, but allowing annual vaccines (COVID, influenza) after 3 months to avoid potential cytokine-induced toxicity recurrence while CAR T cells remain active. She acknowledges this represents personal practice patterns pending formal immune reconstitution studies, with most Dana-Farber providers following similar timelines.