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Since the U.S. Food and Drug Administration (FDA) approval of two CAR T-cell therapies, axicabtagene ciloleucel and tisagenlecleucel, experience has highlighted various barriers to their broader access and use, including challenges related to manufacturing a patient-specific product, high costs and inadequate reimbursement, incomplete or nonsustained disease responses, and potential for causing life-threatening toxicities. Research on disparities, application, and practice of hematopoietic cell transplantation (HCT) can inform opportunities to address similar barriers to use of CAR T-cell therapies that are currently available as well as other cellular therapies that are expected to become available in the near future. To ensure optimal patient outcomes, these therapies should preferably be administered at centers that have experience and established quality processes and practices. We review opportunities for centers, manufacturers, payers, and policy makers to address barriers to care. We also provide a summary of available and alternative payments models for commercial CAR T-cell and other cellular therapies.<\/jats:p>","DOI":"10.1200\/edbk_279151","type":"journal-article","created":{"date-parts":[[2020,4,29]],"date-time":"2020-04-29T11:54:57Z","timestamp":1588161297000},"page":"e27-e34","source":"Crossref","is-referenced-by-count":36,"title":["Expanding Access to Chimeric Antigen Receptor T-Cell Therapies: Challenges and Opportunities"],"prefix":"10.1200","author":[{"given":"Ankit","family":"Kansagra","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Farnia","sequence":"additional","affiliation":[{"name":"Center for Clinical Value, Blue Cross Blue Shield Association, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navneet","family":"Majhail","sequence":"additional","affiliation":[{"name":"Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"bibr1-EDBK_279151","doi-asserted-by":"crossref","first-page":"1868","DOI":"10.1038\/s41409-019-0451-2","volume":"54","author":"Kansagra AJ","year":"2019","journal-title":"Bone Marrow Transplant"},{"key":"bibr2-EDBK_279151","doi-asserted-by":"crossref","first-page":"2305","DOI":"10.1016\/j.bbmt.2019.08.015","volume":"25","author":"Jain T","year":"2019","journal-title":"Biol Blood Marrow Transplant"},{"key":"bibr3-EDBK_279151","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.0977"},{"key":"bibr4-EDBK_279151","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1709866"},{"key":"bibr7-EDBK_279151","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1804980"},{"key":"bibr8-EDBK_279151","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1182\/blood-2019-130983","volume":"134","author":"Jaglowski S","year":"2019","journal-title":"Blood"},{"key":"bibr9-EDBK_279151","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1707447"},{"key":"bibr11-EDBK_279151","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1182\/blood-2018-99-110623","volume":"132","author":"Nastoupil LJ","year":"2018","journal-title":"Blood"},{"key":"bibr12-EDBK_279151","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1182\/blood-2018-99-117199","volume":"132","author":"Jacobson CA","year":"2018","journal-title":"Blood"},{"key":"bibr13-EDBK_279151","doi-asserted-by":"crossref","first-page":"e76","DOI":"10.1016\/j.bbmt.2018.12.068","volume":"25","author":"Kansagra AJ","year":"2019","journal-title":"Biol Blood Marrow Transplant"},{"key":"bibr14-EDBK_279151","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2019.229781"},{"key":"bibr15-EDBK_279151","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2019.06.012"},{"key":"bibr16-EDBK_279151","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2009.12.529"},{"key":"bibr17-EDBK_279151","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/j.bbmt.2017.12.800","volume":"24","author":"Hong S","year":"2018","journal-title":"Biol Blood Marrow Transplant"},{"key":"bibr18-EDBK_279151","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2011.214"},{"key":"bibr19-EDBK_279151","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.jcyt.2017.09.005","volume":"20","author":"Zhu F","year":"2018","journal-title":"Cytotherapy"},{"key":"bibr20-EDBK_279151","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.gde.2018.06.003","volume":"52","author":"Hudecek M","year":"2018","journal-title":"Curr Opin Genet Dev"},{"key":"bibr21-EDBK_279151","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-019-0564-6"},{"key":"bibr22-EDBK_279151","doi-asserted-by":"publisher","DOI":"10.1186\/s13045-018-0568-6"},{"key":"bibr23-EDBK_279151","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1910607"},{"key":"bibr24-EDBK_279151","doi-asserted-by":"publisher","DOI":"10.1097\/HS9.0000000000000186"},{"key":"bibr26-EDBK_279151","doi-asserted-by":"publisher","DOI":"10.1186\/s40425-018-0460-5"},{"key":"bibr27-EDBK_279151","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1038\/bmt.2011.126","volume":"47","author":"Faucher C","year":"2012","journal-title":"Bone Marrow Transplant"},{"key":"bibr28-EDBK_279151","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-019-04696-2"},{"key":"bibr29-EDBK_279151","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1038\/bmt.2015.246","volume":"51","author":"Delamater PL","year":"2016","journal-title":"Bone Marrow Transplant"},{"key":"bibr31-EDBK_279151","unstructured":"MIT-CBI. 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