Outpatient Management of CAR-T and Teclistamab for Patients with Lymphoma and Multiple Myeloma

Background Patients (pts) receiving FDA-approved chimeric antigen receptor T-cell (CAR-T) therapy or Bispecific antibody (BsAb) are commonly managed inpatient (INPT) We have previously described Mayo Clinic outpatient practice (HBO) to manage these treatments. In 2023, HBO management were updated to include home health visits and outpatient/home management of initial CRS. Here, we report outcomes of our updated practice. Methods We retrospectively analyzed medical records and remote monitoring data of adult pts who received SOC CAR-T or BsAb between 10/2020 and 7/2023 at Mayo Clinic, Rochester. under an IRB approved protocol. Results In 3/2023, pts deemed to be low risk for severe CRS (fever onset>=3 days from infusion, CRP<100) received HBO management for grade 1 CRS, including administration of tocilizumab. Nine pts met these criteria and their outcomes were compared to those who received initial INPT CRS management (INPT, n=17) during the same timeframe, as well as the outcome of 164 pts who had CRS management INPT prior to our practice change (Table 1). Two-third of the pts with initial outpatient CRS management did not require hospitalization. Median time to hospitalization trended later than those managed inpatient at the onset of CRS. However with fewer admissions in the initial CRS HBO group, the average hospitalization days (LOS) per patient treated for that group was lower compared to initial INPT CRS management. Data on additional pts will be presented at TCT.In 1/2023, home health visits by the community paramedic was incorporated into practice in place of clinic visits on HBO. Home health visit team communicated with HBO staff to review assessment and plan. Changes in HBO utilization with the incorporation of community paramedics will be presented.Finally, 24 pts received 223 BsAb infusions on HBO. Among these pts, 220/223 (99%) doses were performed on HBO and 204/220 (93%) infusions never required admission for management. Twenty pts enrolled in RPM (Figure 1).In terms of CRS, majority were Grade 1 (12/13, 93%) which responded to steroids alone. Only 1 pt received tocilizumab. The rate of second CRS event after management of first CRS with steroid (dexamethasone/prednisone) was 15% (2/13). These second CRS episodes also resolved with steroid alone.In August 2023, patients were managed with DEX at home at onset of CRS. Additional data on these outcome will be presented. Conclusion Our data showed that additional advances in outpatient practice, including initial outpatient management of CRS and home visits are feasible, safe and reduce hospital resource utilization. Updated data on additional patients and new BsAb in practice will be presented.