Comparative analysis of cell therapy infusion workflows at clinical sites

Improving cell reinfusion to enhance the efficacy of chimeric antigen receptor T-cell therapy and alleviate complications

Adoptive cell therapy (ACT) is a rapidly expanding area within the realm of transfusion medicine, focusing on the delivery of lymphocytes to trigger responses against tumors, viruses, or inflammation. This area has quickly evolved from its initial promise in immuno-oncology during preclinical trials to commercial approval of chimeric antigen receptor (CAR) T-cell therapies for leukemia and lymphoma (Jun and et al., 2018) [1]. CAR T-cell therapy has demonstrated success in treating hematological malignancies, particularly relapsed/refractory B-cell acute lymphoblastic leukemia and non-Hodgkin's lymphoma (Qi and et al., 2022) [2]. However, its success in treating solid tumors faces challenges due to the short-lived presence of CAR-T cells in the body and diminished T cell functionality (Majzner and Mackall, 2019) [3]. CAR T-cell therapy functions by activating immune effector cells, yet significant side effects and short response durations remain considerable obstacles to its advancement. A prior study demonstrated that the therapeutic regimen can induce systemic inflammatory reactions, such as cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), tumor lysis syndrome (TLS), off-target effects, and other severe complications. This study aims to explore current research frontiers in this area.

SOHO State of the Art Updates and Next Questions Updates on Building Your CAR-T Cell Program

Chimeric antigen receptor T-cell (CAR-T) therapy has significantly impacted treatment algorithms and clinical outcomes for a variety of patients with hematologic malignancies over the past decade. The field of cellular immunotherapy is currently experiencing a rapid expansion of the number of patients eligible for CAR-T therapies as approvals are being seen in earlier lines of therapy. With the expanded patients eligible for these therapies, more treatment centers will be necessary to keep up with demand. Building a cellular therapy program can be a daunting task, and therefore, we present our experience with building a clinical cellular therapy program.

A hub-and-spoke model to deliver effective access to chimeric antigen receptor T-cell therapy in a public health network: the Catalan Blood and Tissue Bank experience

BACKGROUND AIMS

To describe and analyze whether a hub-and-spoke organizational model could efficiently provide access to chimeric antigen receptor (CAR) T-cell therapy within a network of academic hospitals and address the growing demands of this complex and specialized activity.

METHODS

The authors performed a retrospective evaluation of activity within the Catalan Blood and Tissue Bank network, which was established for hematopoietic stem cell transplantation to serve six CAR T-cell programs in academic hospitals of the Catalan Health Service. Procedures at six hospitals were followed from 2016 to 2021. Collection shipments of starting materials, CAR T-cell returns for storage and infusions for either clinical trials or commercial use were evaluated.

RESULTS

A total of 348 leukocytapheresis procedures were performed, 39% of which were delivered fresh and 61% of which were cryopreserved. The network was linked to seven advanced therapy medicinal product manufacturers. After production, 313 CAR T-cell products were shipped back to the central cryogenic medicine warehouse located in the hub. Of the units received, 90% were eventually administered to patients. A total of 281 patients were treated during this period, 45% in clinical trials and the rest with commercially available CAR T-cell therapies.

CONCLUSIONS

A hub-and-spoke organizational model based on an existing hematopoietic stem cell transplantation program is efficient in incorporating CAR T-cell therapy into a public health hospital network. Rapid access and support of growing activity enabled 281 patients to receive CAR T cells during the study period.

Delivering externally manufactured cell and gene therapy products to patients: perspectives from the academic center experience

The recent success of the commercialization of CAR-T and other immune effector cells has led to the rapid expansion of clinical trials using cellular therapy products. The expansion of both investigational and commercially available cell therapies has been driven largely by products that are manufactured outside the point-of-care medical center by industry partners or other third parties. The delivery of externally manufactured products to patients requires a coordinated effort with the medical center, as it may be responsible for collection/processing of starting material, shipping, receipt, storage and release for administration of the drug product. As medical centers are grappling with increasing demands for supporting externally manufactured products, they have been forced to modify their processes to handle this demand in reactive rather than proactive fashion. The cell processing facility (CPF) plays a critical role to ensure proper handling and safety of the product as it is transported from the medical center to the manufacturer and back to the patient for infusion. In this mini-series, we have invited several CPFs from medical centers to share their experience, including how they have implemented processes and procedures to successfully ensure product integrity as they cooperate with industry/third parties to deliver novel cell therapy products. For the purpose of this mini-series, we focus on externally manufactured products that fall into the category of biologics that comprise human cells, tissues or cellular and tissue-based products (HCT/Ps) and are regulated under section 351 of the Food and Drug Administration's Public Health Service Act, or advanced therapy medicinal products (ATMPs) governed by regulatory bodies such as the European Medicines Agency. The goal of this collection of articles is to engage professionals in the discussion about issues related to externally manufactured products and, together, define best practices and potential standards for the cell therapy community to streamline the safety and delivery of externally manufactured products to our patients.