Scaling CAR T-Cell Therapy to Community Sites

This episode, "Scaling CAR T-Cell Therapy to Community Hospital Sites," features Dr. Porter detailing the mandates behind his health system's two community programs.

Dr. Porter describes building community CAR T-cell therapy sites around two firm mandates. The first was choosing sites carefully: his initial community hospital, an affiliate about 60 miles from the academic center, serves a population that rarely travels into the city but is not a small, resource-limited facility. It has a full emergency department, ICU, and supportive staff, which he says is essential; a site without that infrastructure would not be appropriate, no matter how underserved its patients are.

The second mandate was parity: care at a community site had to match the academic site exactly, using the same quality standards. FACT accreditation presented a chicken-and-egg problem, Dr. Porter explains, since earning it requires a minimum volume of prior infusions. His solution was having sites operate under FACT-equivalent standards from day one while working toward formal accreditation, and coordinating with manufacturers to onboard commercial CAR T-cell products before accreditation was complete. That meant building physician and nursing expertise, cell therapy coordinators, quality managers, and SOPs, plus engaging emergency, ICU, neurology, infectious disease, and nephrology support, all backed by substantial institutional investment.

After the first site succeeded, Dr. Porter's program expanded to Pennsylvania Hospital, notable for its long-standing transfusion-free autologous transplant program serving Jehovah's Witness patients nationally, a group many clinicians hesitate to treat given transfusion needs for cytopenias. The site developed a transfusion-free CAR T-cell program to extend access to these patients, again backed by full emergency and ICU infrastructure.

Over two years, the two sites together infused more than 60 patients who, Dr. Porter says, largely would not have reached or been referred to the academic center otherwise. One site has since earned FACT accreditation and the other is in process, though both have operated under the academic program's 15-year quality standard from the start.

Our next episode, "Why More Sites Are Treating CAR T Without FACT Accreditation," turns to why a growing number of sites are choosing to treat patients before FACT accreditation catches up.