Coordinating Post CAR T Care in MM: Bridging Academic and Community Practice

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Post-CAR T care coordination requires structured collaboration between academic medical centers and community oncologists to ensure optimal patient outcomes.Louis Williams, MD, implements a joint visit approach for the first 3 months postinfusion, maintaining oversight while reestablishing patients with their primary oncologists for routine care, including laboratory monitoring, intravenous immunoglobulin administration, and supportive care. This dual-supervision model provides safety nets for managing intermediate-term complications while preserving established patient-physician relationships.

The academic center maintains responsibility for specialized monitoring, including infectious disease follow-up, assessment of prolonged cytopenias, and evaluation of evolving neurotoxicities. After the initial 90-day period, follow-up frequency transitions to every 2 to 3 months based on patient preferences and community oncologist comfort levels. This flexible approach accommodates varying practice patterns while ensuring continuity of specialized care for CAR T–specific complications.

Critical education components for community partners include recognition of delayed neurotoxicities, cranial nerve palsies, and immune effector cell enterocolitis.Peter Voorhees, MD, emphasizes the importance of educating patients, caregivers, and community oncologists about the warning signs requiring immediate reengagement with the CAR T center. The collaborative model prevents patients from falling through care gaps while leveraging community oncologists' expertise in routine myeloma management and the academic center's specialized CAR T knowledge.