CAR T

There’s No Place Like Home: Remote Digital Monitoring Strategies for CAR T Therapy

The following article is the sole perspective of the author and does not necessarily represent the opinion of ASTCT.

The rapid evolution of chimeric antigen receptor (CAR) T-cell therapy and T cell-engagers (TCEs) has reshaped the treatment landscape in hematologic malignancies. However, it has also introduced new operational challenges, including how to monitor patients intensively for toxicity without over-reliance on inpatient resources. As outpatient CAR T models expand and TCEs move into earlier lines of treatment, digital health monitoring is emerging as a pragmatic extension of traditional toxicity surveillance (Majhail et al., 2025; Rahbari et al., 2025).

Remote vital sign monitoring and electronic patient-reported outcomes (ePROs) stand at the forefront. While evidence specific to immune effector therapies is in the early stages, the convergence of wearable biosensors and digital symptom platforms offers a glimpse into a more proactive, data-driven model of post-treatment monitoring and care.

High Frequency Remote Vital Sign Monitoring for Earlier CRS Detection

Fever remains the sentinel sign of cytokine release syndrome (CRS), making temperature monitoring a logical entry point for remote patient monitoring (RPM). Wearable temperature sensors exemplify this approach (Fyfe et al., 2025). FDA-cleared wearable temperature sensors, including disposable cutaneous patches (e.g., TempTraq) worn by patients, continuously measure body temperature every 6 minutes.

Beyond single-parameter physiologic monitoring, newer platforms expand the concept to multiparameter assessment (Weller et al., 2024).

One method integrates the temperature measuring patch with mobile health-enabled remote photoplethysmography (rPPG) technology, allowing estimation of heart rate, respiratory rate, blood pressure, and heart-rate variability through contact-free facial scans utilizing the patient’s own smartphone camera (Lin et al., 2025).

Other strategies use multiple wearable devices or wearable armbands (Rajeeve et al., 2026). These technologies allow for self-monitoring by patients or can transmit data wirelessly to a cloud-based dashboard, enabling clinicians to receive alerts when predefined thresholds are exceeded.

Continuous monitoring provides several theoretical advantages for patients receiving CAR T and TCE therapies. Continuous data streams may identify temperature trends before intermittent vital checks, potentially allowing earlier detection and intervention in CRS to prevent progression to higher grade toxicity and hospitalization. Remote monitoring can also support earlier discharge and outpatient treatment models with less on-site monitoring required. Finally, automated alerts may decrease reliance on manual temperature measurements, thus reducing both patient and caregiver burden.

Such multimodal monitoring is particularly appealing for CAR T and TCE therapies, where subtle changes in vital signs may precede clinically significant CRS, sepsis, and other common toxicities. Early institutional pilots suggest feasibility and high adherence with these RPM strategies, though standardized thresholds and response pathways remain an area of active development (Cox et al., 2024; Lin et al., 2025; Moore et al., 2025).

ePRO Monitoring: Capturing Neurotoxicity and Symptom Burden

While vital sign monitoring excels at detecting physiologic changes, many meaningful symptoms detected in clinic such as fatigue, confusion, word-finding difficulty, or functional decline are best captured directly from patients or caregivers. ePRO systems allow patients to report symptoms in real time via mobile apps or web portals, often triggering automated triage alerts for care teams without requiring a clinic visit (Banerjee et al., 2021).

In oncology, ePRO-driven monitoring has been associated with improved quality of life and reduced acute care utilization, largely by enabling earlier intervention (Cherny et al., 2022). For CAR T and TCE therapies, the rationale is even stronger. ICANS, for example, often begin with subtle cognitive changes that may be recognized first by patients or families (Efficace et al., 2022).

Despite these potential benefits, published interventional trials specifically in CAR T or TCE populations remain limited. Most current implementations are feasibility or workflow studies, and many programs adapt existing oncology ePRO platforms rather than CAR T-specific tools, such as immune effector cell encephalopathy (ICE) scoring. Nevertheless, consensus efforts are underway to define core symptom domains (e.g., neurologic, constitutional, infectious, and functional) that should be routinely captured in digital monitoring frameworks (Hughes et al., 2025; Khatsuria et al., 2024).

Remote Monitoring in Action: Real-World Experiences

Several institutions have begun implementing remote monitoring into their workflow, however published experiences are limited. Sarah Cannon Transplant and Cellular Therapy Network provided the most detailed model of how such practices can be incorporated into the workflow for outpatient administration of CAR T, including specifics regarding duration of monitoring, alarm thresholds, frequency of alarms, and the necessary support services (Cox et al., 2023, 2024, 2024; Majhail et al., 2025). Other centers have reported on outcomes in pilot implementation studies (Dholaria et al., 2025; Paludo et al., 2021; Pettinati et al., 2026; Rajeeve et al., 2026).

Taken together, these experiences primarily outline a strategy focused on continuous RPM that is overseen by a 24/7 centralized virtual nursing service, typically provided by a third-party vendor that services multiple cancer centers, that can easily connect with patients to triage RPM alerts. If there is concern for CRS or ICANS based on clinical assessment, the virtual RN can escalate to the local care team for management. To effectively and safely implement these operational workflows, rigorous institution-specific standardized clinical pathways and operating procedures must be developed in an iterative and multidisciplinary process to ensure proper care coordination.

As institutions further explore digital health monitoring and technologies, several practical issues consistently arise. First, continuous data streams require clearly defined escalation protocols to prevent clinical teams from being overwhelmed with false-positive alerts, which can lead to alarm fatigue. In addition, determining the optimal methods for integrating these data into the electronic health record remains an important challenge for workflow efficiency and documentation. Finally, the use of these technologies depends on access to smartphones, digital literacy, and caregiver support, which may influence who benefits from these tools and raise concerns about equitable access.

Digital monitoring is unlikely to completely replace in-person assessment, but it offers an important adjunct as these therapies continue shifting toward outpatient delivery. Additional prospective trials are needed to determine whether combining wearable vital-sign monitoring with structured ePRO capture can reduce severe toxicity, shorten hospital stays, reduce clinic visits, or improve patient-centered outcomes.

For transplant and cellular therapy programs, there is an opportunity to leverage technology not simply to collect more data, but to intervene earlier and tailor care more precisely. As continuous temperature patches and multi-vitals measurement platforms mature, these tools may help redefine what “close monitoring” looks like in the era of CAR T and TCE therapies, extending vigilance beyond the hospital walls while preserving safety for patients.

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