VIDEO: Considerations when monitoring patients with myeloma after CAR-T

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Our patients, they get CAR-T cells either in the hospital or outpatient. So, we either admit the patient for about 10 days, we give them the cells, you know, on the first day, their own cells. And then we monitor them for side effects in the hospital for about 10 days. And we all know that most of the side effects, they happen, you know, during that hospital stay so we can catch a lot of 'em during that hospital stay, which is good. Now, you know, rarely patients get discharged, you know, on their day 10, right? And then they come back with delayed cytokine release syndrome potentially, you know, one day or two days after they get discharged. That's rare. But if that happens, they call us, we get them back into the hospital, and we treat them.

Now, if we do it outpatient, you know, the cells are infused outpatient and then the patients are monitored just basically daily. They come to the infusion center, you know, once a day and then they get, you know, their blood work done to monitor their blood counts and such, and they get their vital signs checked. You know, they see a provider, they examine them, they make sure that, you know, they don't have any side effects. If they do, we admit them. If they don't, they go back home and then they come back, you know, the next day for the same thing. And then on day five, we do admit them to the hospital.

So, we know that cytokine release syndrome with cilta-cell, which is the commercial product that we use most often, CRS happens after about a week from infusion. So, it's okay to watch these people outpatient, because we know CRS is less likely to happen within the first week. And then we admit them on day five for about five days to monitor them in the hospital. So, they're outpatient for about five days and then in the hospital for five days.

Now, after they get discharged, you know, these patients get labs twice a week initially to monitor them, and then they're seen at least, you know, within the first week, at least once within the first week after they leave the hospital. After that, you know, if anything happens, you know, our nurses are available, they call us after hours. We have people who are covering. So, it's been going pretty well the way we have it structured here. But outpatient and inpatient are happening here at the Cleveland Clinic and so far, we have not really seen any downsides to doing this outpatient in terms of safety.