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Abstract
Background: Outpatient and ambulatory models of chimeric antigen receptor T-cell (CAR-T) therapy have been developed to reduce inpatient bed use and improve patient-centered delivery. However, safety and feasibility are difficult to interpret because published evidence differs by CAR-T product, costimulatory domain, disease context, monitoring pathway, and definition of outpatient care.
Objective: To synthesize evidence on feasibility, toxicity, hospitalization burden, intensive care use, healthcare resource utilization, and cost-related outcomes associated with outpatient CAR-T therapy in adults with hematologic malignancies.
Methods: A PRISMA-structured systematic review was conducted using PubMed/MEDLINE, Web of Science core collection, Scopus, and Cochrane CENTRAL for studies published from 1 January 2017 to 1 January 2026. Eligible studies included adults receiving CAR-T therapy in outpatient infusion, ambulatory monitoring, early-discharge, telemedicine-supported, remote-monitoring, or community-site pathways and reported extractable clinical or resource-use outcomes. Meta-analysis was not performed because of heterogeneity; synthesis followed SWiM principles.
Results: Twelve original studies published from 2022 to 2025 were included. Selected 4-1BB-based pathways showed the clearest signal for admission avoidance: in one tisa-cel cohort, 68 of 72 patients were managed outpatient and 36.1% were admitted within 30 days; in the multicenter tisa-cel cohort, 45% of outpatient recipients required unplanned admission. OUTREACH showed feasible community-site liso-cel monitoring, with 70% monitored outpatient and 25% of outpatient-monitored patients never hospitalized. CD28-based outpatient axi-cel/brexu-cel pathways were feasible but often still led to admission: in a prospective outpatient axi-cel trial, 19 of 20 patients were admitted within four weeks, and in ZUMA-24, 93% were hospitalized after outpatient axi-cel. Claims analyses suggested lower index or 30-day costs for outpatient site of care, but they lacked toxicity grading and detailed pathway information.
Conclusions: Outpatient CAR-T therapy is feasible for carefully selected adults, but outpatient initiation should not be equated with hospital-free treatment. Current evidence supports structured, product- and risk-adapted outpatient programs rather than unselected ambulatory administration.
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Article Type: Review Article
ELECTRON J GEN MED, Volume 23, Issue 4, August 2026, Article No: em744
https://doi.org/10.29333/ejgm/18988
Publication date: 21 Jul 2026
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