Building the Infrastructure for Outpatient CAR T-Cell Therapy

In an interview with Pharmacy Times, Cassandra “Cassie” Perkey, PharmD, BCOP, regional clinical pharmacist at American Oncology Network, discussed the personnel, infrastructure, hospital partnerships, and scheduling strategies required to safely deliver CAR T-cell therapy in a community oncology setting.

Perkey explained that practices need a dedicated multidisciplinary team that includes physicians, advanced practice practitioners, pharmacy staff, nursing leadership, and financial personnel. Team members must be prepared to meet frequently throughout the onboarding process, while patients are moving through treatment, and during postinfusion follow-up. Ongoing collaboration also supports continuous quality improvement as the program gains experience.

Physical infrastructure is another important consideration. Clinics need dedicated space to store CAR T-cell products, equipment to thaw the cells, and sufficient room to accommodate the shipping containers used to transport them. Perkey noted that these requirements may appear straightforward but can create challenges for smaller community practices with limited infusion or pharmacy space. Purchasing and positioning the necessary equipment should therefore be addressed early in the planning process.

A strong partnership with a nearby hospital is also essential. Although the goal may be to provide treatment entirely in the outpatient setting, patients remain at risk for serious adverse events that may require urgent hospital or intensive care. Community practices must establish reliable communication with hospital leaders, emergency departments, and intensive care teams so patients can be accepted quickly and managed appropriately when complications arise.

Perkey also described CAR T-cell scheduling as a complex puzzle that often must be planned backward from the intended infusion date. Clinics must coordinate lymphodepleting chemotherapy, product delivery, infusion, and postinfusion monitoring within manufacturer-recommended windows. Her team generally aims to receive the product on Monday and infuse on Tuesday, limiting storage time while maximizing weekday follow-up. Scheduling infusion early in the week gives clinicians more opportunities to assess patients during regular business hours, particularly during the first month, when frequent telephone, telehealth, and in-person monitoring may be required.