Insights from the Sarah Cannon Transplant and Cellular Therapy Network’s experience scaling outpatient CAR-T across multiple sites.
At this year’s ASH meeting, one theme cut across sessions, posters, and hallway conversations: advanced therapies are accelerating faster than the care models designed to deliver them. CAR-T, bispecifics, and emerging gene-modified treatments continue to expand, yet access is increasingly constrained by operational capacity rather than clinical possibility, especially as other stringent criteria—including FACT accreditation and REMS—are being modified.
Among these modalities, CAR-T has become the leading force pushing the field toward scalable outpatient delivery. Its intensity, monitoring requirements, and historical dependence on inpatient care have compelled programs to innovate—and these innovations are beginning to define what broader advanced therapy delivery could look like.
The 2025 review by Dr. Navneet Majhail and other clinician leaders at Sarah Cannon Transplant and Cellular Therapy Network details how their team has advanced this shift, implementing outpatient CAR-T across multiple centers through standardized pathways and continuous clinical monitoring from Current Health.
Their experience offers a glimpse into how outpatient models can expand access not only for CAR-T, but for the entire category of advanced therapies poised to follow, and make inpatient beds deliver more value.
Below are the key insights from their experience.
1. “Outpatient-first” creates scalability.
Across the Sarah Cannon network, more than 80% of patients evaluated for CAR-T were eligible for outpatient care using shared criteria for performance status, comorbidities, psychosocial support, caregiver readiness, and the ability to participate in monitoring.
This finding highlights a fundamental shift underway in advanced therapy delivery:
inpatient expansion is no longer the scalable solution.
At ASH and across the field, centers consistently described the same constraints—finite bed availability, staffing shortages, and increasing competition for inpatient resources. Meanwhile, demand for CAR-T and other advanced therapies continues to grow across lymphoma, myeloma, solid tumors, and autoimmune diseases.
Majhail et al. underscore this systemic pressure:
“Outpatient delivery… can alleviate capacity challenges treatment centers have faced that have partly impacted access to CAR-T therapies.”
Outpatient CAR-T becomes the mechanism to increase throughput without increasing the inpatient footprint. It allows programs to:
- open more treatment slots
- reduce bed dependency
- accommodate more patients per unit time
- distribute care across multiple centers rather than concentrating it on a single inpatient service
Most importantly, this model enables growth at a pace that matches clinical demand—not infrastructure constraints.
In this way, outpatient CAR-T is a capacity strategy for the entire advanced therapies ecosystem.
2. Toxicities are predictable—and predictable means scalable.
SCTCTN’s real-world data show familiar toxicity patterns:
- 70–79% experienced any-grade CRS
- 29–33% experienced any-grade ICANS
But only:
- 4–5% experienced grade ≥3 CRS
- 6–9% experienced grade ≥3 ICANS
Most importantly:
“98% of CRS and 96% of ICANS episodes occurred within the first 15 days of CAR-T infusion.”
A defined risk window, coupled with standardized escalation pathways, allows centers to:
- Front-load monitoring resources
- Reduce unnecessary inpatient observation
- Streamline staffing models
- Increase patient throughput without increasing risk
Predictability is the backbone of any scalable clinical model, and CAR-T toxicity behaves predictably enough to support outpatient-first workflows.
3. Continuous clinical monitoring is the infrastructure that enables scale—and reassures caregivers.
Majhail et al. describe a clinical monitoring model through Current Health built around continuous vital sign tracking, temperature assessment, blood pressure checks, patient-initiated alerts, and a 24/7 virtual nursing team (Current Health’s Clinical Command Center) that reviews data, triages patients, and escalates care.
This team is essential not only for safety, serving as an extension of the site’s clinical team, but also for caregiver confidence, which directly affects outpatient feasibility.
The authors note:
“A trained individual [must] monitor clinical data outputs, rapidly identify clinically relevant issues, and escalate them in a timely manner for appropriate management.”
And just as importantly, they capture the emotional impact:
“Patients and caregivers have provided feedback that knowing a nurse is monitoring for toxicity and available 24/7 allays their anxiety and enhances confidence in receiving outpatient care.”
Caregiver reassurance is not a soft benefit. It is a structural enabler of access. Without reliable monitoring, outpatient CAR-T places a heavy burden on caregivers, making them less willing and sometimes less eligible to participate. With continuous clinical monitoring in place, the burden shifts from the caregiver to the clinical system—unlocking outpatient eligibility for more patients and more diverse populations.
This is how clinical monitoring becomes a lever for scale, not just safety.
4. Hospitalizations remain common—but shorter, more purposeful, and more efficient.
Even with outpatient initiation, 82–86% of patients required hospitalization within 30 days.
But the meaningful metric for access is not hospitalization frequency—it’s duration. The authors report:
“The median duration of hospitalization ranged from 4 to 6 days… [versus] 16 days for CAR-T recipients who did not meet criteria for outpatient administration.”
This shift is transformational. Outpatient models do not eliminate inpatient care—they concentrate it within windows where clinical intervention is actually needed. This optimizes bed utilization and expands a center’s ability to treat more patients with fewer beds.
5. Standardization—not individual heroics—is what makes outpatient CAR-T reproducible at scale.
he SCTCTN model works because variability is intentionally engineered out of the system.
As the authors describe:
“Clinical pathways and standard operating procedures… are applied across multiple sites, such as for outpatient assessment and monitoring, and evaluation and management of CRS and ICANS.”
This includes:
- Shared eligibility criteria
- Common CRS/ICANS decision trees
- Aligned documentation and order sets
- ED readiness protocols
- Unified monitoring and escalation criteria
- Consistent education across clinicians and sites
This is how programs move from “capable of outpatient CAR-T” to consistently and confidently delivering it across a network.
6. Access is the driving force behind outpatient CAR-T innovation.
Majhail et al. emphasize that capacity—not science—is what limits CAR-T uptake today:
“Capacity challenges… have been identified among factors that may limit the number of patients who can receive this therapy.”
And they warn that demand is only increasing:
“These issues will likely worsen with the anticipated increase in the number of patients who need cellular therapies.”
Outpatient CAR-T with clinical monitoring is emerging as one of the only operational strategies capable of meeting this rising demand while maintaining safety.
It enables:
- More treatment sites
- More eligible patients
- Reduced hospitalization burden
- Higher throughput
- Care closer to home
- Equitable access across geographies
Outpatient CAR-T is, increasingly, the mechanism by which access is expanded and sustained.
Final Thought: scaling outpatient CAR-T isn’t about doing more—it’s about doing it differently
As ASH made clear, the future of advanced therapies will be defined not only by scientific breakthroughs, but by how quickly—and how confidently—we can expand access. Sarah Cannon’s multicenter experience shows that outpatient CAR-T supported by continuous clinical monitoring and standardized workflows is not just safe; it is a scalable operating model that meets today’s capacity pressures without relying on additional inpatient beds.
For centers evaluating how to evolve their own delivery models, three takeaways stand out:
- Outpatient is now the most viable path to growth. More than 80% of patients can be safely managed in this setting when the right systems are in place.
- Continuous clinical monitoring reduces caregiver burden and strengthens safety. This is essential for program adoption and expansion.
- Standardized workflows—not one-off heroics—drive reproducibility across sites. This is the foundation for scale.
If you’re exploring how to strengthen your outpatient advanced therapy program, or how these models could fit within your clinical, operational, or staffing constraints, we can help.
Download the Sarah Cannon case study to learn more about the impact of this model, or connect with our team to discuss how we support centers implementing outpatient CAR-T or bispecifics and preparing for the next wave of advanced therapies.
These insights are based on the article:
Navneet S. Majhail et al. Outpatient Administration of Chimeric Antigen Receptor T-Cell Therapy Using Remote Patient Monitoring. JCO Oncol Pract 21, 1601-1608(2025).