Considerations for Patients With B-Cell Lymphoma CAR T to Be Treated in the Community Setting

Dr Friedman raises concerns about the “4 out of 5” patients who should receive CAR T but don't, attributing this to social determinants of health, geographic barriers, age-related factors, and other access challenges. He acknowledges the trend toward community-based CAR T delivery driven by market forces, insurance changes, and regulatory evolution, while recognizing the complexity and potential risks of expanding administration sites.

Dr Jacobson emphasizes that while CAR T has become safer, severe toxicities still occur occasionally, requiring experienced teams for optimal management. She supports expanding access to more sites but not universal availability, stressing the need for demonstrated proficiency including adequate volume, intensive care unit capabilities, and subspecialty consultation services (neurology, infectious disease, cardiology). Sites must meet specific standards for safe administration while maintaining expertise in toxicity recognition and management.

The discussion acknowledges future complexity with anticipated lower-toxicity products, potential solid tumor applications, and expanding indications. Lynch reinforces that despite progress; patients can still experience severe toxicities requiring specialized care. The panel agrees on a balanced approach supporting increased access through qualified centers while maintaining safety standards and avoiding premature expansion to inadequately prepared facilities.