Making outpatient advanced therapies work.
What does it take to run CAR-T and bispecifics delivery outside the hospital without compromising safety?
In conversation with Current Health CMO, Dr. Matt Wilkes and Memorial Sloan Kettering physician researchers, Dr. Sridevi Rajeeve and Dr. Neha Korde walked through the approach they use today that includes:
- Inclusive eligibility
- Early adverse-event detection supported by continuous monitoring and a 24/7 clinical team
- Clear CRS and ICANS thresholds
- Training that keeps main campus and regional sites aligned
Why this shift is happening.
As advanced therapies expand into more indications and move into earlier lines of treatment, these treatments will apply to more patients. Programs are responding by redesigning delivery so appropriate patients can receive treatment closer to home. The conversation is focused on the operating model that makes this practical in busy cancer centers and clinics: straightforward rules, reliable signals, and coverage you can trust at any hour.
For Memorial Sloan Kettering, inpatient beds come at a premium and traveling into Manhattan presents a significant burden for many patients. A decentralized approach thst connects community sites to the main cancer center is helping expand access and provide easier experiences.
“This model becomes essential as bispecifics and CAR-Ts move into earlier lines. We will simply not have the inpatient bed capacity unless we shift more patients to outpatient care.” — Dr. Neha Korde
How MSK runs outpatient delivery.
Eligibility that expands access
Dr. Rajeeve and Dr. Korde use a straightforward rubric that balances access and risk. Patients need a willing caregiver and the ability to reach care in about ninety minutes if an alert occurs. High disease burden or active neurologic concerns can shift a patient to inpatient care. The goal is to be precise, not restrictive, which allows MSK to include regional centers as well as the Manhattan campus.
Continuous monitoring with 24/7 specialty nurse oversight
To detect adverse events like CRS, patients are sent home with the Current Health wearable device, which streams vital signs to a clinical dashboard. Current Health’s Clinical Command Center monitors the data, triages alarms, and escalates to MSK under defined pathways. Daily huddles keep the Clinical Command Center nurses and provider teams aligned.
“For example, patients sometimes wait until 6:00 AM instead of coming in at 3:00 AM when they spike a fever… that’s when continuous monitoring is so useful to make sure they are not deteriorating.” — Dr. Sridevi Rajeeve
Clear and efficient escalation
When fever is detected, patients follow clear instructions, present to urgent care or the emergency department, and move through an observation pathway with access to tocilizumab when indicated. The intent is timely, protocol-driven care rather than long inpatient stays.
“Every patient goes home with 10 mg of dexamethasone. They don’t take it unless they have a fever, and then they present to the ER where the team administers tocilizumab and observes them for 24–72 hours.”
— Dr. Sridevi Rajeeve
Early experience and what it suggests
In an 18-patient pilot of bispecific therapy using outpatient step-up dosing with continuous monitoring, about 89% completed step-up entirely in the outpatient setting. Fevers that occurred were detected and escalated under protocol. After guideline updates, adding prophylactic tocilizumab at the first step-up was associated with smoother courses and no fevers in subsequent patients within this cohort.
“We were able to keep almost 90% of patients in the outpatient setting — patients who otherwise would have been hospitalized for a week or more.” — Dr. Sridevi Rajeeve
Earlier feasibility work in CAR-T found the Current Health platform delivered several hours of early warning before clinical fever when using continuous monitoring. Earlier, reliable signals paired with clear rules enable planned interventions and a calmer experience for clinicians, patients, and caregivers.
Making community sites part of one service
MSK operates a hub-and-spoke network. Devices are shipped to regional centers in advance. Lead nurses from the main campus help train local teams. The same monitoring approach, thresholds, and escalation pathways apply across locations. Patients receive advanced therapies closer to home while remaining under the umbrella of a single, coordinated service.
Dr. Korde shared: “MSK uses a hub-and-spoke model with a main campus in Manhattan and multiple MSK-run regional care centers. Myeloma specialists travel to these centers to see patients in their own communities, reducing the need for everyone to come into the city. This approach helps overcome logistical barriers, allowing us to monitor patients and deliver therapies locally while maintaining a strong, integrated safety net of care.”
Building a culture that can absorb rapid innovation.
Effective change management has emerged as a central theme, with Dr. Korde underscoring that introducing new care models requires institution-wide coordination—not just a new protocol. Every stakeholder group needed clear algorithms, aligned expectations, and training. The work showed that education cannot be a one-time event; it requires ongoing reinforcement and communication to ensure consistency across teams.
Dr. Rajeeve highlighted that even small operational details—from caregiver instructions to device usage—can influence clinical safety, making continuous feedback loops essential. As new data and guidelines surfaced, workflows had to be rapidly updated and re-shared across inpatient, outpatient, and regional teams. Together, these efforts demonstrate that successfully scaling innovative therapies relies as much on shared understanding and adaptability as on the underlying clinical evidence.
“You can’t build this once and walk away — the workflow has to evolve with new data, new therapies, and turnover across departments.” — Dr. Neha Korde
