{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T13:07:47Z","timestamp":1781010467769,"version":"3.54.1"},"reference-count":38,"publisher":"Aboutscience Srl","issue":"1","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Grhta"],"abstract":"<jats:p>Introduction: Follicular Lymphoma (FL) is the second most common lymphoid malignancy, with 20% of patientsprogressing within 24 months of first-line therapy. Chimeric antigen receptor T-cell (CAR-T) therapies have improved outcomes in relapsed or refractory FL, yet their use requires significant resources and complex care pathways. Although outpatient CAR-T programs have shown promising safety and feasibility, limited evidence exists on their organizational, economic, and ethical implications in the Italian healthcare setting. This study compares the current CAR-T pathway for FL patients with a virtual optimized scenario incorporating outpatient management in selected phases.Methods: A multidimensional framework was applied to assess differences between standard in-hospital care(Standard Pathway) across three Italian public hospitals (Genoa, Rome, Perugia) and a partially outpatient model(Efficient Pathway). Literature review and expert consultations validated existing practices and informed optimization criteria. Structured surveys provided quantitative and qualitative inputs. Economic modelling estimated three-year full costs using patient-level data, while organizational and ethical aspects were evaluated through Likert scales.Results: Efficient Pathway shifted bridging therapy, post-infusion monitoring, and follow-up to outpatient settings,reducing total costs from \u20ac 611,070 (As-Is) to \u20ac 497,421 (To-Be). Organizational benefits included increasedbed capacity (average score: 4.9\/6) and consumable utilization (average score: 4.3\/6), while ethical gains wereobserved in treatment accessibility (average score: 4.3\/6).Conclusions: Introducing outpatient management into CAR-T phases may provide economic, organizational, andethical advantages when supported by clear eligibility criteria and structured monitoring. As CAR-T indicationsexpand, pathway redesign will be essential to ensure equitable access and sustain healthcare system resources.<\/jats:p>","DOI":"10.33393\/grhta.2026.3722","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T12:41:35Z","timestamp":1781008895000},"page":"133-145","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing CAR-T therapy delivery in the Italian healthcare system: economic and organizational insights in follicular lymphoma"],"prefix":"10.33393","volume":"13","author":[{"given":"Andrea","family":"Vitagliano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marzia","family":"Bonfanti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6512-6080","authenticated-orcid":false,"given":"Emanuele","family":"Angelucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Di Rocco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9139-1729","authenticated-orcid":false,"given":"Maria Paola","family":"Martelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Del Sarto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0548-6226","authenticated-orcid":false,"given":"Marianna","family":"Morani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Lucchetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Palladino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"18642","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"19839","unstructured":"Kaseb H, Ali MA, Gasalberti DP, et al. Follicular lymphoma. StatPearls. 2024. Online https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK538206\/ (Accessed January 2026)."},{"key":"19840","doi-asserted-by":"crossref","unstructured":"Kanas G, Ge W, Quek RGW et al. Epidemiology of diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) in the United States and Western Europe: population-level projections for 2020-2025. Leuk. Lymphoma. 2022;63:54-63. https:\/\/doi.org\/10.1080\/10428194.2021.1975188","DOI":"10.1080\/10428194.2021.1975188"},{"key":"19841","doi-asserted-by":"crossref","unstructured":"Casulo C, Dixon JG, Le-Rademacher J, et al. Validation of POD24 as a robust early clinical end point of poor survival in FL from 5225 patients on 13 clinical trials. Blood. 2022;139(11):1684-1693. https:\/\/doi.org\/10.1182\/blood.2020010263 PMID:34614146","DOI":"10.1182\/blood.2020010263"},{"key":"19842","doi-asserted-by":"crossref","unstructured":"Ferreri AJM, Zinzani PL, Messina C, et al. Burden of illness in follicular lymphoma with multiple lines of treatment, Italian RWE Analysis. Cancers (Basel). 2023;15(17):4403. https:\/\/doi.org\/10.3390\/cancers15174403 PMID:37686679","DOI":"10.3390\/cancers15174403"},{"key":"19843","doi-asserted-by":"crossref","unstructured":"Kanate AS, Majhail N, DeFilipp Z, et al. Updated indications for immune effector cell therapy: 2023 Guidelines from the American Society for Transplantation and Cellular Therapy. Transplant Cell Ther. 2023;29(10):594-597. https:\/\/doi.org\/10.1016\/j.jtct.2023.07.002 PMID:37422194","DOI":"10.1016\/j.jtct.2023.07.002"},{"key":"19844","doi-asserted-by":"crossref","unstructured":"Fowler NH, Dickinson M, Dreyling M, et al. Tisagenlecleucel in adult relapsed or refractory follicular lymphoma: the phase 2 ELARA trial. Nat Med. 2022;28(2):325-332. https:\/\/doi.org\/10.1038\/s41591-021-01622-0 PMID:34921238","DOI":"10.1038\/s41591-021-01622-0"},{"key":"19845","doi-asserted-by":"crossref","unstructured":"Yamshon S, Gribbin C, Alhomoud M, et al. Safety and toxicity profiles of CAR T Cell therapy in Non-Hodgkin Lymphoma: a systematic review and meta-analysis. Clin Lymphoma, Myeloma Leuk. 24(6):e235-e256.e2. https:\/\/doi.org\/10.1016\/j.clml.2024.02.007","DOI":"10.1016\/j.clml.2024.02.007"},{"key":"19846","doi-asserted-by":"crossref","unstructured":"Landsburg DJ, Maziarz RT, Moskop A, et al. Efficacy and safety of Tisagenlecleucel in patients with relapsed\/refractory follicular lymphoma: a real-world analysis from the Center for Blood and Marrow Transplant Research (CIBMTR) Registry. Blood. 2024;144(suppl 1):4398-4398. https:\/\/doi.org\/10.1182\/blood-2024-204207","DOI":"10.1182\/blood-2024-204207"},{"key":"19847","doi-asserted-by":"crossref","unstructured":"Brudno JN, Maus MV, Hinrichs CS. 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