Building a Community-Academic Partnership for CAR T-Cell Therapy in Myeloma

Matthew J. Frigault, MD, clinical director of the Cellular Immunotherapy Program at Mass General Brigham Cancer Institute, asked what practical steps referring oncologists can take and what an ideal interaction with an academic medical center looks like. Adam D. Cohen, MD, director of Myeloma Immunotherapy and professor of medicine at the Hospital of the University of Pennsylvania, described a 2-way partnership that begins with early referral.

The referring physician can often deliver bridging therapy, Cohen explained, with the treating center advising on the optimal regimen and the washout period needed to minimize myelotoxicity after infusion. Once patients are past the acute window for cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS), a smooth handoff back to the community becomes the priority.

Cohen’s team uses a checklist for that transition:

• Continue antiviral and Pneumocystis prophylaxis

• Check blood counts for delayed cytopenias and provide growth factor support as needed

• Give intravenous immunoglobulin (IVIG), which is key after both CAR T-cell therapy and bispecific antibodies

• Watch for late complications such as enterocolitis

• Monitor for second primary malignancies through age-appropriate cancer screening

The goal, Cohen says, is for the center to manage the short-term period around CAR T-cell therapy and for patients to return to care in their local community, with periodic check-ins. Ideally, they are back home, off treatment, in remission, and enjoying a good quality of life.