Administration of chimeric antigen receptor (CAR)–modified T-cell therapy has evolved to become a mainstay treatment in patient with hematologic malignancies. CAR-T patients are frequently hospitalized one to four weeks in order to ensure close monitoring for adverse effects, such as Immune Effector Cell–Associated Neurotoxicity Syndrome (ICANS), and Cytokine Release Syndrome (CRS). Unfortunately, this often incurs substantial cost and burden on both the patients and the healthcare system. Our study compared the outcomes of patients who were discharged early vs patients who had regular discharges following the inpatient administration of CAR-T.

Patients who were infused between 2024-2025 at a single center were included in the cohort. Patients eligible for early discharge, which occurred on Day +1 to +2 from CAR T-cell infusion, were identified prior to their hospital admission. Eligibility was based on age>18, completion of treatment, and safe discharge as part of the care plan. Chi-square and Fisher's exact tests were used to compare outcomes, where applicable. P<0.05 was considered statistically significant.

Of the 75 adult patients included, 30 were discharged early, 1 was excluded from subsequent analyses as they were deemed not early discharge but left against medical advice on Day +2. Our results showed that non-whites were more likely to be early discharge (23% vs 7%; p=0.08). Otherwise, our findings demonstrate that no major significant differences were found in the outcomes of patients who were discharged early vs the ones with regular discharges. Specifically, rates of CRS were similar between the regular and early discharges (61% vs 60%, p=0.9); ICANS (48% vs 37%, p=0.3) were also similar between the two groups. Additionally, the incidence of disease progressions, survival, and infection within 30 days of discharge were not different between cohorts. Our findings highlight that 30 days readmission rates were higher in the early discharge cohort (33% vs 70%, p=0.002). This was mainly due patients presenting with ICANS symptoms, with early discharge patients presenting more with Grade 0 and 1, and regular discharge patients presenting for more severe, Grade 2 ICANS (Grade 0 37.0% vs 47.6%; Grade 1 16.7% vs 38.1%; Grade 2 44.4% vs 14.3%; Grade 3 1.9% vs 0.0%; p=0.03). Patients with early discharge were readmitted at a median of 6 days post discharge, which was similar to non-early discharge patient readmissions (4 days). Adding the readmission time to the original hospital stay, patients with early discharge still maintained a shorter hospital stay of a median of 7 days compared to non-early discharge patients whose median original hospital stay was 13 days post-infusion.

Inpatient administration of CAR-T places a substantial burden on the healthcare system, patients and their families. Increased hospital stays mean more resource allocation, as well as an increased risk of hospital acquired infections. A decreased length of stay also means lesser psychological burden, with patients able to return home sooner. Although it is important to closely monitor CAR-T recipients, our preliminary findings support early discharge after inpatient administration of CAR-T. It is worthwhile noting that while early discharges present many advantages, careful considerations must be taken prior to implementing the process. Its feasibility rests on several factors including adequate infrastructure, well trained staff, close outpatient follow up, and thorough patient education. Because early discharge patients are still at risk of ICANS, it is important to educate patients and their caregivers on recognizing the signs and symptoms of CAR-T side effects. Consistent follow up and monitoring is also required as patients post CAR-T are immunocompromised putting them at risk of opportunistic infections. These findings demonstrate with an appropriate home discharge protocol, careful selection of patients, and training, early discharge can be safe for patients.

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2025
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