Work

Expanding Access to Life-Prolonging Cellular Therapies: A Case Series of the First Three CAR T-cell Recipients at an Urban Public Safety-Net Hospital

Year: 2026

Type: article

Abstract: Introduction Chimeric antigen receptor T-cell (CAR-T) therapy is effective for relapsed/refractory hematologic malignancies, but access is limited by socioeconomic barriers such as low income, poor health literacy, transportation challenges, and lack of insurance. In 2025, our urban, public, safety net hospital launched a CAR-T program. We report our initial experience, focusing on the successes and challenges of implementation in a resource-limited setting. Methods A retrospective chart review of the first 3 patients (pts) treated with CAR-T was conducted. Data collected included diagnosis, prior treatment, CAR-T response, barriers to care, and pt-specific challenges. Results Three males (ages 37, 64, 69; 2 Black, 1 White) with relapsed/refractory disease received CAR-T (n=1 non-Hodgkin's lymphoma (NHL); n=2 multiple myeloma (MM)). All pts had Karnofsky score 80%. Insurance: 1 pt had marketplace/private, 2 pts had Medicaid. Stanford Integrated Psychosocial Assessment scores were 8 (n=2, good) and 21 (n=1, minimally acceptable). All pts received fludarabine/cyclophosphamide for lymphodepleting chemotherapy. Products used were Lisocabtagene maraleucel (Length of stay (LOS) 16d) and Idecabtagene vicleucel (LOS 12d). Pt with NHL had primary refractory disease and received 2 prior lines of therapy. After receiving CAR-T therapy, imaging demonstrated stable disease. One MM pt had relapsed disease post autologous transplant/maintenance; the other MM pt had 2 prior lines of therapy. Responses after CAR-T were partial remission (n=1) and very good partial remission (n=1). No ICU transfers for cytokine release syndrome or immune-effector cell associated neurotoxicity syndrome occurred. Readmissions after discharge were not seen. All pts faced significant barriers to care, including limited insurance, transportation instability, missed appointments, psychosocial stressors, and limited caregiver support. Each patient was assigned a dedicated coordinator who provided intensive, hands-on navigation across all phases of care, critical to ensuring therapy completion in this high-risk population. Conclusion Commercial CAR-T therapy can be delivered safely and effectively in a public safety-net hospital, expanding access for underserved populations. Despite complex barriers, all pts completed therapy without major complications. Our experience underscores the need for robust care coordination, patient education, and structured follow-up in resources limited settings.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.jtct.2025.12.287

Authors: Muhammad Saad Waqas, Batoul Sadek, Tara Barker, Sarah Crisp, Bernadette McQuigg, Tamila L Kindwall-Keller

Institutions: MetroHealth, Case Western Reserve University, MetroHealth Medical Center

Language: English

Topic: CAR-T cell therapy research

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: hybrid

Estimated APC paid: $3,650