Outpatient Versus Inpatient Axicabtagene Ciloleucel CAR T-Cell Therapy in Non-Hodgkin's Lymphoma: Insights from a US Multicenter Transplant and Cellular Therapy Network - PubMed
3 hours ago
- #CAR T-cell therapy
- #Non-Hodgkin's Lymphoma
- #Outpatient care
- Axicabtagene ciloleucel (axi-cel) CAR T-cell therapy is approved for relapsed/refractory diffuse large B-cell lymphoma (DLBCL), typically administered in an inpatient (IP) setting due to risks of cytokine release syndrome (CRS) and neurotoxicity (ICANS).
- Outpatient (OP) administration of axi-cel, supported by structured care pathways, prophylactic dexamethasone, and remote patient monitoring (RPM), shows comparable outcomes to inpatient therapy.
- A retrospective study of 143 DLBCL patients (47 OP, 96 IP) found no significant differences in CRS rates (83% OP vs. 85% IP) or severe CRS (grade ≥2: 47% OP vs. 46% IP).
- OP patients had less frequent (34% vs. 56%) and less severe ICANS (grade ≥2: 17% vs. 33%), possibly due to higher prophylactic dexamethasone use (89% OP vs. 21% IP).
- OP therapy reduced median hospital length of stay (7 vs. 15 days) with 13% avoiding hospitalization entirely, while ICU utilization was similar (28% OP vs. 23% IP).
- Multivariable analysis showed no significant association between therapy setting and CRS/ICANS severity, overall survival (OS), or progression-free survival (PFS).
- OP axi-cel administration is feasible with comparable safety and efficacy to IP, supporting broader adoption in selected patients with RPM support.