Mapping pharmacist roles across the chimeric antigen receptor T-cell therapy care continuum: A scoping review.

BACKGROUND

Chimeric antigen receptor T-cell (CAR-T) therapy represents a transformative but operationally demanding treatment modality, requiring rigorous coordination across clinical, regulatory, and logistical domains. While pharmacists are widely acknowledged as integral members of CAR-T programs, the full breadth and impact of their contributions have not been systematically characterized.

METHODS

A scoping review was conducted in accordance with the Arksey and O'Malley framework and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, with the protocol registered in the International Prospective Register of Systematic Reviews (PROSPERO). Multiple electronic databases were searched, with an initial search conducted to July 2025 and an updated search subsequently extending coverage through 2026. Eligible sources included original studies, narrative reviews, practice guidelines, consensus documents, commentaries, book chapters, and conference proceedings describing pharmacist involvement in CAR-T therapy. Data were extracted using a standardized charting form and synthesized descriptively.

RESULTS

Fifteen sources out of 859 studies published between 2020 and 2026 were included. The evidence base was heterogeneous and predominantly descriptive, comprising narrative reviews, expert commentaries, guidance and consensus documents, original observational or process evaluation studies, a book chapter, and a conceptual framework. Pharmacists were reported to contribute across the entire CAR-T care pathway, encompassing program development and governance, electronic prescribing systems, medication management, product ordering and chain-of-identity traceability, supportive care and toxicity preparedness, patient education, pharmacovigilance, regulatory and financial stewardship, and quality improvement initiatives. Observational evidence indicated that pharmacist-led process interventions may reduce system-level safety risks, particularly within medication-use processes and identity traceability, and may contribute to shorter treatment timelines and expanded outpatient continuity of care. However, standardized clinical and economic outcome data remained limited across the included literature.

CONCLUSIONS

Pharmacists fulfilled a critical, multifaceted role in the safe, effective delivery of CAR-T therapy, consistently acting as stewards of medication safety, product traceability, and regulatory compliance. The current evidence base, while informative, lacks prospective and comparative studies evaluating pharmacist-specific interventions against standard care. Future research should prioritize the development of standardized role definitions and the robust measurement of clinical, operational, and economic outcomes as CAR-T therapy continues to expand into broader practice settings.