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AP-008

Myeloma, 65 to 74, rural, dual eligible, 76 to 150 miles

CAR-T · Phase 3, Coverage & Authorization · 22 days in stage · 14 barriers, 4 blocking

Falling behindOne task is 6 days overdue
1

Diagnosis & Referral

From diagnosis to first contact with an accredited center.

Any order, all required

Start ahead · work beginning here for later phases

  • Confirm the center’s caregiver requirement and any flexibility · Caregiver & psychosocial clearance · for phase 2
  • Start caregiver planning now; explore paid-caregiver and respite options · Caregiver & psychosocial clearance · for phase 2
  • Connect family to caregiver stipend / paid-leave resources and advocacy · Caregiver & psychosocial clearance · for phase 2
  • Enroll in manufacturer assistance / copay programs · Financial toxicity / out-of-pocket burden · for phase 2
  • Arrange non-emergency medical transport (NEMT) and confirm coverage · Transportation barrier · for phase 2
  • Plan bridging early with a standardized protocol; avoid bendamustine before apheresis · Manufacturing / collection & vein-to-vein risk · for phase 4
  • Arrange professional interpreters and language-concordant materials · Language & communication barrier · for phase 2
  • Secure subsidized / free housing near the center early · Housing insecurity / relocation burden · for phase 2
2

Candidacy Evaluation

The work-up that determines whether the center will proceed. Most tests run in parallel and all feed the selection decision.

Any order, all required

Start ahead · work beginning here for later phases

  • Verify benefits and secure prior authorization before apheresis · Insurance coverage & prior-authorization · for phase 3
  • Ask about early leukapheresis + cryopreservation to protect T-cell fitness · Manufacturing / collection & vein-to-vein risk · for phase 4
3

Coverage & Authorization

Securing payer approval and financial clearance for the specific therapy.

Any order, all required
4

Collection & Preparation

Obtaining the cells and getting the patient ready. This is where CAR-T and allogeneic transplant diverge.

CAR-T track

Shared preparation — in parallel with collection

Any order, all required
5

Treatment

Conditioning, infusion, and the acute monitoring window.

6

Recovery & Follow-up

Monitoring, transition back home, and long-term survivorship.