Hi, I haven't posted on here in a while. I'm a first year Heme/Onc fellow at a mid tier academic program. I was wondering if anyone could shed some light on what CAR-T therapy might be like as a career.
Can someone start working in this field as a career straight out of fellowship or would there need to be further specialization after graduating like must I do a nonaccredited CAR-T fellowship?
Would I need to focus on BMT or hematologic malignancies in fellowship?
What will the demand in this field become, job stablility in light of emerging therapies?
What are salary expectations?
What kind of facilities would this be done out of? I heard something like its starting to be done at other places, and not just academic centers.
What would the caseload be like per day? Would I also see regular hematologic malignancies?
Anything else I should be thinking about as I explore this as an option?
Appreciate your thoughts
We do about 50-60 CART per year so not a ton but projected to increase to >100 in 2-3 yrs. Would be enough volume for 2-3 faculty currently we have 1.5 (one faculty member is partly bmt too). I think it is a career option but I would consider two things;
1) how to get significant clinical experience prior to a career
2) try and get on some research or protocols for cart to better familiarize yourself with how the protocols work, crs monitoring etc etc
It’s doable but it’s super niche at this time, keep that in mind. Myeloma and lymphoma are doing the lions share of these. An interesting development is that cart specialists could gain more volume if you’re also involved in seeing all patients at high risk for ICANS including those on bispecifics. Some centers are considering this…
Re; your specific question. I’d almost never recommend non accredited fellowships but you do need to get some specific cart experience to be able to get a job. Is it possible to get some experience within your program or if not get your program to sign off on a rotation at an outside institution?
I would definitely focus on hematologic malignancies in fellowship. Myeloma and lymphoma in particular as these represent >95% of cart as SOC. As far as investigational products In acute leukemias there are cd 5 and cd7 cart in t all, bispecifics (19,22) in b all, cd22 in b all, auto-01 in b all, cd123, cd33 and cll-1 and NK car in AML. So you can see the myeloma and lymphoma are much more established but acute leukemias are probably not that far behind (though ALL>>>AML bc at least there is SOC auto cart in ALL at the moment).
Building on the above, I believe there is a significant expansion of cart use ongoing and with more and more products being studied this should only continue to increase. Much will depend on whether or not any solid tumor and autoimmune cart become SOC in the next 5 yrs. If they do the field will further blow up. I would never pursue this but I could see how it could be appealing.
Salary expectations would be exactly the same as other academic heme malig positions depending on where geographically and at what institution but probably 250-325 for academics starting.
It is true non academic centers are looking into this but I would be very skeptical that any of these places become powerhouses at least initially. They’re not going to be leaders on any of the studies and will never attract the patients like the academic centers will (for the most part with rare caveats). Of course pay would be higher at a center like this fwiw to you…
As far as caseload per day I would envision it like any other heme malignancy job. Clinic a few days per week 3-4 months of service maybe more like 6mo in your first year. Case load will vary based on how busy the program is but at any one time we average 10 inpatients who are within 30 days +/- cart administration.
