Abstract
Background
Chimeric Antigen Receptor T-cell (CAR-T) therapy offers a potentially curative option for patients with relapsed/refractory hematologic malignancies. However, its delivery is limited to academic centers, mostly accredited by the Foundation for the Accreditation of Cellular Therapy (FACT), which represents less than 200 centers in the United States. In contrast, there are over 5000 community medical centers, but the degree to which these centers are individually prepared to deliver cell therapy remains unknown.Objective
To evaluate institutional interest, readiness, and perceived barriers to CAR-T implementation.Methods
We conducted a cross-sectional, electronic survey targeting practicing hematologists and hematologist/oncologists in the United States. A 31-question instrument was developed and distributed via email in April 2025 using Qualtrics. The survey assessed provider classification, clinical experience, institutional infrastructure, staffing, CAR-T–related knowledge and interest, and perceived barriers to CAR-T delivery. Only physicians actively practicing in community-based, non-FACT–accredited centers were eligible to participate.Results
Our survey received 157 responses from hematologists/oncologists across 44 states. Over half of respondents (n= 84, 53.5%) had more than 10 years of experience, and 50.3% (n= 79) reported diagnosing more than 50 hematologic malignancies in the past year. Nearly all (n= 152, 96.8%) reported caring for CAR-T–eligible patients within the past three years; however, only 50.3% (n= 79) indicated that the majority of these patients was successfully refered and received the treatment.
Knowledge of CAR-T cell therapy among hematologists/oncologists was high, with 98.1% (n= 154) describing themselves at least as well-informed. Institutional interest in offering CAR-T was reported by 66.9% (n= 105) of respondents, with 67.5% (n= 106) noting similar enthusiasm among their teams. Core oncology services were widely available, including chemotherapy administration (n= 148, 94.5%), emergency department coverage (n=155, 99%), ICU capacity (n= 151, 96.5%), and 24/7 call systems (n=102, 64.5%). Notably, 20.4% (n= 32) of centers offered bone marrow transplantation, and 42% (n=66) reported experience with bispecifics. Infrastructure limitations included access to apheresis services (n=83, 52%), and in-house cell-processing capability (n=70, 45%). Clinical Research Activity was present in 29 centers (18.47%).
While 67% (n=106) of centers had at least two hematologists/oncologists willing to lead a CAR-T program, only 46% (n=73) had oncology-trained nurses available. The most commonly reported institutional barriers were provider coverage and reimbursement, while the primary patient-level challenges were cost and insurance approval delays.Discussion
Although nearly all surveyed clinicians reported CAR-T–eligible patients, only half of those patients successfully received the treatment. Community hematologists report strong interest and possess foundational infrastructure to support CAR-T delivery. Core oncology services—such as emergency coverage, chemotherapy facilities, and ICU capacity—are widely present, suggesting a viable base upon which advanced cell therapy programs could be developed. However, CAR-T delivery demands additional resources, including apheresis capabilities, quality management system, and specialized lab infrastructure, which remain limited.
Staffing assessments revealed mixed readiness. Physician motivation appears strong, but shortages in nursing expertise and dedicated CAR-T program personnel are common. Notably, 32 centers currently perform BMT and bispecifics, 47 bispecifics. With only ~200 active CAR-T centers nationally, this suggests potential for a ~40% expansion in capacity if readiness is appropriately is supported.Conclusion
CAR-T therapy remains inaccessible to many patients treated in community settings; however, a substantial number of centers appear to have the foundational readiness to deliver this therapy. While hematologist/oncologist motivation and patient need are evident, targeted investment, workforce development, and structural support are essential to bridge the gap between interest and implementation.
