Advancement of clinical practice in delivering CAR T-cell therapy: impact on healthcare resource utilization and comparison with autologous stem cell transplantation in patients with relapsed/refractory large B-cell lymphomas

TL;DR

CAR T-cell therapy is more efficient and less resource-intensive than stem cell transplants for treating certain lymphomas, leading to shorter hospital stays and better patient outcomes.

Contribution

The study documents process improvements in CAR T-cell therapy and compares healthcare resource utilization with ASCT in routine clinical practice.

Findings

Improvements in CAR T-cell therapy processes reduced hospitalization by 5 days and personnel time by 15% from 2022 to 2023.

CAR T-cell therapy had 77% less personnel time and 70%-75% shorter hospitalization compared to ASCT.

Process modeling revealed significant patient-centered efficiencies in CAR T-cell therapy over ASCT.

Abstract

In patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL) who are either refractory to first-line therapy or relapse within 12 months, chimeric antigen receptor (CAR) T-cell therapy is more effective than salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation (ASCT) as second-line therapy. Adoption of CAR T-cell therapy into routine clinical practice involves a period of adaptation and refinement of clinical processes. We aimed to document the evolution of clinical processes for CAR T-cell therapy during 2022 and 2023, and compare healthcare resource utilization (HCRU) associated with CAR T-cell and ASCT processes in routine clinical practice. ClipMedPPM software-based process modeling was used to assess HCRU for patients with R/R LBCL receiving CAR T-cell or ASCT therapy, mapping 991 and 1174 processes associated with CAR T-cell therapy in 2023 and 2022, respectively, and 1874 processes associated with ASCT over both years. Improvements in lymphodepletion therapy administration and assessment and management of CAR T-cell therapy-specific adverse events led to a 5-day (30%) reduction in hospitalization and a 15% decrease in total personnel time in the CAR T-cell therapy process from 2022 to 2023. HCRU for CAR T-cell therapy was almost half that of ASCT, with 77% less personnel time for therapy administration. Hospitalization for CAR T-cell therapy was 70%-75% shorter than for ASCT therapy (11–13 vs. 44 days). These patient-centered process efficiencies provide patients with reduced hospitalization time. Understanding this evolution is vital for addressing complexities of advanced treatments, enhancing patient care quality, and optimizing resource allocation.

The online version contains supplementary material available at 10.1007/s00277-025-06564-y.

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