So, hi, I'm Radhika Bansal. I'm a research fellow at Mayo Clinic Rochester presenting our outpatient CAR T practice and Toclistimab practice in patients with lymphoma and multiple myeloma. So, at Mayo Clinic Rochester, we have this unique practice in which we give CAR T and bispecific antibodies to the patients in the outpatient setting. So, they come in, they get LD chemo and CAR T infusions, and then they check in daily for the first seven or 14 days as per REMS. And after that, it's as clinically indicated. And they are managed by the same care team of MDs, APPs, and RNs who administer care both on the hospital-based outpatient side and the inpatient side. We also enroll them in the remote patient monitoring program prior to CAR T through month one, which is basically our way of, you know, making sure that they are able to check their vitals or signs of neurotoxicity at home. And all of that data is transmitted via EMR to our HBO team. If anything is outside of predefined thresholds, we get an alert. Those alerts are addressed by our HBO team. So, this year at ASH, we are presenting certain updates to our existing practice, like the first one being we are managing initial CRS grade one with tocilizumab on our outpatient side. And the second is that after day 14 of CAR T, in the second half of the month, when the patient is still living close to the treatment center, we select patients to enroll them in the community paramedic program. So, now this community paramedic goes to the patient lodging two to three times a week and assesses them, draws blood, also has the capability to administer medications at their home. And he also discusses his findings with the team in our HBO side, and all the clinical decisions are made by the HBO team. So, what this essentially does is it reduces the number of patient visits to HBO and also reduces the need for interventions on HBO so the patient can still be at home with their family and feel more comfortable. Now, in the third part, we are describing our practice with bi-specific antibodies, which we launched on the outpatient side in the same cell therapy domain. And recently, what we have started doing is for CRS grade one, we administered dexamethasone at home for the initial management. And, you know, comparable to what was reported in the clinical trial, we do see that majority of the CRS does occur after the first dose during the step of dosing, majority of admissions occur during that time. So, yeah, that is our practice so far. It is feasible. It is safe and additional enhancements to this outpatient setting are possible. And remote monitoring does help. Monitor patient compliance and identify those early changes of adverse events like CRS and helps optimize, you know, escalation of care.
HealthTree • December 10, 2023