AP-011

Myeloma, 26 to 64, urban, Medicaid, limited English

CAR-T · Phase 6, Recovery & Follow-up · 34 days in stage · 10 barriers, 4 blocking

Falling behind34 days in recovery and follow-up, past the 28-day target

Follow one barrier

Diagnosis & Referral

From diagnosis to first contact with an accredited center.

Any order, all required

Start ahead · work beginning here for later phases

Start the single-case agreement / out-of-state enrollment as early as possible · Single-case agreement / out-of-network · for phase 3
Enroll in manufacturer assistance / copay programs · Financial toxicity / out-of-pocket burden · for phase 2
Arrange professional interpreters and language-concordant materials · Language & communication barrier · for phase 2
Plan bridging early with a standardized protocol; avoid bendamustine before apheresis · Manufacturing / collection & vein-to-vein risk · for phase 4

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
Secure authorization before apheresis to avoid a stalled start · Single-case agreement / out-of-network · for phase 3
Ask about early leukapheresis + cryopreservation to protect T-cell fitness · Manufacturing / collection & vein-to-vein risk · for phase 4

Securing payer approval and financial clearance for the specific therapy.

Any order, all required

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

Conditioning, infusion, and the acute monitoring window.

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