Outpatient CAR T-cell Therapy

During outpatient CAR T-cell therapy, you will receive the full course of treatment on an outpatient basis rather than being admitted to the hospital for 10 to 14 days. 

Weeks prior to treatment, your T cells will be collected through a simple, non-invasive process called apheresis. This process is similar to a blood donation, but after the T cells are removed, the remaining blood is returned back into your body. The cells are then sent to a lab to be “supercharged” for treatment. The cells multiply at the lab until they number in the millions and are ready for infusion.

Three days prior to CAR T-cell infusion, you will receive chemotherapy on an outpatient basis, followed by two rest days before infusion. The CAR T-cells are then given by infusion back into your bloodstream, where they will continue to multiply and begin attacking cancerous cells.

You and a caregiver will make daily visits to the 10th floor of the Center for Care and Discovery. Visits will take approximately three to five hours. Tests and treatments are performed in a private treatment bay equipped with a comfortable chair. You may read, watch a personal wall-mounted TV or surf the web during treatment. 

Each day, when treatment is over, you will return home or to nearby accommodations near the UChicago Medicine campus. The outpatient unit is open from 7 a.m. to 7 p.m., seven days a week.

Advantages of outpatient stem cell transplant include the following:

• The same, effective CAR T-cell therapy treatment is given while allowing you to rest after therapy in familiar and comfortable surroundings.
• Daily check-ins with nurses and physicians ensure you are closely monitored for any signs of infection or side effects. If necessary, your care can be easily transitioned to the inpatient unit to complete the remaining treatment course.
• Being home or in a hotel or designated apartment near campus encourages greater movement, such as to and from the kitchen, bedroom and bathroom. Under certain precautions, you may leave home, go shopping or elsewhere during outpatient treatment. Moving around and being active is associated with better treatment outcomes.
• Many patients report that being with family and friends at home is beneficial to their overall state of mind, making treatment easier.

Outpatient CAR T-cell therapy is offered on a case-by-case basis after a thorough evaluation. UChicago Medicine currently provides outpatient treatment to patients who meet the following criteria:

• Diagnosed with acute lymphoblastic leukemia, certain types of non-Hodgkin lymphoma or multiple myeloma. In addition, we offer outpatient cellular therapy for patients with certain solid tumor types as part of a clinical trial.
• There is no age limit for outpatient CAR T-cell therapy.
• Good overall physical condition with no evidence of significant heart or kidney disease or other relevant medical conditions
• Live within an hour drive of the UChicago Medicine campus or willing to stay at a designated hotel or apartment near campus
• Have a responsible, designated caregiver(s) who can accompany you 24 hours a day, seven days a week. Caregivers do not need medical training and can be a relative or friend. There should be one “point person” designated caregiver for communication purposes. Note that other responsible caregivers may assist with transportation, accompanying patients to/from appointments, being at home and more.
• You and your caregiver must be able to measure and record your vital signs with our provided vital sign monitoring equipment. We will train patients and their caregiver on how to accurately measure vital signs so you are comfortable performing these tests.
• You and your caregiver agree to follow guidelines to prevent infection. For example, you must wear a mask when outside the home and adhere to a strict medication regimen.

Over time, our goal is to offer outpatient CAR T-cell therapy to as many patients as possible, as we recognize the benefits for patients and their families.

For several years, UChicago Medicine has offered outpatient stem cell transplant, another type of lifesaving cellular therapy, giving our team the experience to determine the best conditions for a good outcome. Based on that program’s results, learnings from years of successful CAR T-cell therapy care and in consultation with other leading cellular therapy programs, we are proud to offer this option to patients most likely to benefit from this outpatient approach. 

Every step of the care process is designed to ensure safe, effective care. Daily visits and our commitment to close communication with patients and caregivers help safeguard against complications so that any concerns are addressed in a timely manner.

If hospitalization is necessary, patients are easily transitioned to our dedicated inpatient unit. Even if you must spend time overnight in the hospital, you may eventually resume outpatient treatment in certain situations.

Typically, signs of infection, such as fever, development of low blood pressure, confusion or trouble breathing, will require hospitalization. In some cases, we’re able to prescribe treatments for these issues on an outpatient basis. Most patients receiving outpatient CAR T-cell therapy on an outpatient basis will not be admitted to the inpatient unit.

Designated caregivers play a critical role in the treatment process and are essential to a good outcome. There can be more than one responsible caregiver, but there should be a single designated “point person” caregiver who will communicate with the UChicago Medicine team. Requirements for caregivers include:

• Accompanying the patient 24 hours a day, seven days a week during the treatment process. The patient should not be alone.
• Ensuring the patient visits the outpatient CAR T-cell unit daily
• Monitoring the patient for signs of infection, such as fever
• Making sure the patient takes the correct dosage of medications on time
• Helping the patient follow guidelines to prevent infection and illness, such as proper hygiene, eating nutritious meals and getting enough sleep
• Keeping a clean, safe environment for the patient
• Being able to contact the UChicago Medicine team with any questions or concerns, and being able to take the patient to our medical campus should the need arise

Whether the treatment is offered in the hospital or on an outpatient basis, patients and their families receive thorough support and education to prepare for all phases of CAR T-cell therapy.

Candidates for outpatient CAR T-cell therapy and their designated caregivers meet with nursing staff and a social worker to review the process and requirements to ensure successful treatment. Patients and caregivers receive detailed educational materials that outline medication schedules, care for the central venous catheter, monitoring vital signs, spotting signs of infection, how to prepare a safe, clean environment at home, and more.

Our team is available 24 hours a day, seven days a week to answer questions and to coordinate care.