Ambulatory Cellular Therapies Service Continues to Expand

Posted date

Written by

Subscribe to Advances in Hematologic Malignancies

Subscribe Now

Explore Past Issues

Read More

In July 2019, Dana-Farber Cancer Institute launched its ambulatory reduced-intensity-conditioning (RIC) allogeneic stem cell transplant (allo SCT) program, allowing patients to safely undergo this lifesaving cellular therapy while avoiding weeks of hospitalization. Since then, the capacity and volume of this program have grown considerably, with a total of 65 patients undergoing ambulatory RIC allo SCT in fiscal year 2023. Outcomes have been excellent with reassuring safety metrics — the majority of patients not requiring admission to the hospital during their transplant course — and 14 days of hospitalization saved per patient on average. Patient satisfaction has also been high, with this approach to transplant allowing for a closer-to-normal daily routine, greater privacy, more time spent with the patient's caregiver, and a quieter night's sleep, among other advantages.

In January 2022, the ambulatory immune effector cell (IEC) therapy program began at Dana-Farber, starting with the CAR T-cell therapy, lisocabtagene maraleucel (Breyanzi), for patients with relapsed/refractory diffuse large B-cell lymphoma. In March 2023, this program expanded to include ciltacabtagene autoleucel (Carvykti) for patients with relapsed/refractory multiple myeloma. Similar to transplant, this program has been a success, with over one week of hospitalization saved per patient on average, as well as rapid admission and delivery of appropriate medical therapy to patients who have developed the common cytokine release syndrome (CRS) side effect of CAR T-cell therapy. More recently, some ambulatory IEC clinical trials have opened at Dana-Farber, further improving our ability to offer next-generation cellular therapies to our patients without the need for a prolonged hospital stay.

Lastly, the ambulatory transplant program expanded in March 2023 to include patients undergoing high-dose melphalan with autologous stem cell transplant (HDM-ASCT) for multiple myeloma. Out of an abundance of caution, this component of the program started slowly but has now hit full throttle, with ten patients successfully undergoing ambulatory HDM-ASCT between October 2023 and April 2024. An average of 15 days of hospitalization have so far been saved per patient, and rapid admission and delivery of appropriate medical care has not been an issue when needed.

Given the success of our ambulatory cellular therapy delivery to date, the program plans to further expand the scope of outpatient transplant and IEC services at Dana-Farber over the coming year. This will include the delivery of BEAM-ASCT to patients with relapsed/refractory lymphoma as well as additional FDA-approved CAR T-cell therapies. Throughout the continued growth of this service, we will ensure that adequate physician, advanced practice provider, patient navigator, and housing/logistical support is maintained to continue the world-class level of care that our ambulatory cellular therapy patients have so far received.