Access Barriers in CAR T-Cell Therapy

Welcome back to another AJMC Insights series. In "Accreditation, Access, and Outcomes: What Real-World CAR-T Data Tells Us," David Porter, MD opens the series by outlining what still limits access to CAR T-cell therapy access.

Dr. Porter, director of the Center for Cell Therapy and Transplant at the University of Pennsylvania and immediate past president of American Society for Transplantation and Cellular Therapy, frames access as CAR T-cell therapy's foremost unmet need. He clarifies that true access does not mean every patient receives treatment; it means every appropriate patient has it available as an option. Closing that gap requires moving therapy closer to where patients live, so they can reach a center with cell-therapy expertise without traveling long distances. Dr. Porter identifies three parallel priorities: continued safety improvements, since toxicity management is still being refined; sustained efficacy gains; and cost-effectiveness, since an unaffordable therapy limits access for patients, health systems, and society regardless of clinical benefit.

Turning to outpatient administration, Dr. Porter describes adoption as historically slow but now accelerating. He argues the early caution was appropriate: clinicians and health systems needed time to master administration and toxicity management while risks were still poorly understood. As therapies have grown safer and easier to deliver, interest in outpatient care has grown quickly.

Real barriers remain, he says. CAR T-cell therapy is not comparable to routine chemotherapy, where any covering clinician can manage a side effect or refer a patient to the emergency room. It demands specialized personnel available around the clock, plus a physical space equipped to manage patients outside standard emergency care, which he notes is built for acute crises rather than CAR T-specific toxicities. Meeting both requirements, Dr. Porter explains, takes substantial institutional commitment: dedicated funding for staff and space, plus administrative support to build a functioning outpatient program. He predicts continued growth in outpatient CAR T-cell therapy as safety and efficacy keep improving and institutions gain confidence managing patients outside the hospital.

The next episode in this series, "Why FACT Accreditation Still Matters for CAR T-Cell Therapy," turns to why FACT accreditation for CAR T-cell therapy access has endured and where it's evolving.