Real-world CART delivery metrics: Institutional timelines from referral to infusion

Abstract

Abstract Background: Timely delivery of chimeric antigen receptor T-cell (CAR-T) therapy is critical for patients with relapsed or refractory hematologic malignancies, where disease progression can rapidly compromise eligibility. Despite the increasing use of CAR-T therapies, real-world data quantifying institutional delivery timelines remain sparse. We aimed to characterize key intervals in the CAR-T treatment pathway at a single center and compare them to national benchmarks. Methods: We conducted a retrospective review of 34 adult patients who received commercial CAR-T therapy between January 2022 and December 2024 at a university-affiliated community cancer center. For each patient, we recorded the dates of referral, decision to proceed with CAR-T, apheresis, and infusion. We also captured the length of stay (LOS) during the inpatient CAR-T admission. Data were obtained through structured electronic health record review and cross-validated with multidisciplinary case logs. Delivery intervals were summarized using medians and interquartile ranges (IQR). We also explored associations between delivery timelines and clinical variables, including disease subtype and use of bridging therapy. Results: The median times from referral to apheresis were 22.0 days (IQR, 15.0 to 28.0 days), and from referral to infusion were 63.5 days (IQR, 53.5 to 70.0 days). The median time from the decision to proceed with CAR-T to infusion was 57.5 days (IQR, 48.0 to 62.0). The median LOS for the inpatient CAR-T admission was 7.0 days (IQR 7.0 to 9.75). All patients completed leukapheresis, manufacturing, and infusion without attrition due to logistical delays or clinical deterioration. Delivery timelines were consistent across lymphoma subtypes and CAR-T products. The use of bridging therapy and initial disease diagnosis was not significantly associated with longer treatment intervals. Conclusions: In this single-center cohort, CAR-T delivery metrics from referral to infusion aligned with published real-world benchmarks. The absence of process-related attrition and the consistency of timelines across products and disease types reflect effective multidisciplinary coordination. These findings support the feasibility of delivering CAR-T therapy efficiently in a community-affiliated academic setting. Longitudinal tracking of institutional throughput may help identify modifiable delays and promote timely access to cellular therapies.