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While the transfusion medicine physician has historically focused on the prevention of serious adverse events during the collection or transfusion of blood, rapid growth in cellular therapy collections and cellular processing has revealed the need for a greatly expanded role. This new persona, which includes overseeing complex laboratory and apheresis operations, providing clinical consultations, directly interacting with the treating team, securing resources and partnerships to accommodate a large number of research protocols, and providing expert insight into how best to solve or interpret complex patient diagnostic issues is necessary to ensure that cellular therapies are as available, safe, and effective as traditional allogeneic blood transfusions.1, 2 Today's transfusion medicine physician may support several hospitals, some of them remotely, with weekly to quarterly in-person visits. In other areas, oversight of transfusion medicine activities within a hospital may fall under a pathologist primarily focused on anatomic diagnoses. The net result is that too many pathologists are perceived as remote economic gatekeepers who are adjacent to patient care operations, rather than essential members of the patient care team.2, 3 The emergence of licensed and investigational biotherapies has coincided with an opportunity to reinvent the transfusion medicine physician as an active and indispensable part of patient care (Figure 1). Advanced cell and gene therapies are complex to coordinate, expensive to manufacture and require a high degree of inter-disciplinary communication and support—comparable to that required for organ transplants. All currently licensed therapies require dedicated collection and manufacturing runs for each patient. While these drugs initially focused on hematological malignancies, they are rapidly expanding into other disease areas, with 4469 therapies in development,4 further increasing the demand for apheresis and cell therapy laboratory resources. This growing demand is already beginning to exceed what the traditional university-hospital model—originally built around hematopoietic stem cell transplantation—can easily accommodate.5 This evolving landscape presents an opportunity for physicians to position themselves as facilitators and collaborators who “increase value” by using their expertise to move across the traditional departmental silos, ultimately serving as patient advocates who help ensure access to a rapidly increasing portfolio of advanced therapies. True sustainability of clinical biotherapies services will require the collective expertise of a broader group of professionals than solely the transfusion medicine physician. Transfusion medicine specialists (TMS)—a term used here to encompass not only physicians but also nurses, clinical laboratory scientists, quality and regulatory experts, advanced practice providers, and other key contributors—are uniquely positioned to support and lead the interdisciplinary efforts necessary to ensure scalable, equitable, and resilient biotherapies infrastructure. One frequently discussed avenue for increased patient access to cellular therapies is via the collections and laboratory infrastructure of the allogeneic blood collection center. Over the past 10–15 years, a concerted effort to drive cost out of traditional allogeneic blood products, coupled with reduced demand for blood and greater difficulty recruiting volunteer donors, has led to significant consolidation and cost-cutting. Five community-based blood centers now collect two thirds of all blood in the United States.6 Indeed, standardization of allogeneic blood offerings has established a framework for meeting the current good manufacturing practice (cGMP) goals of Safety, Quality, Identity, Potency, and Purity during manufacturing and safeguarding the Rights of Blood Administration (derived from Rights of Drug Administration), resulting in the right blood going to the right patient at the right dose at the right time for the right reason(s), following the right patient education.7, 8 It is possible that the application of some of these principles to the collection and manufacture of cellular therapies could greatly improve patient access and potentially diminish associated healthcare costs. The question that stands before our field is: can the transfusion medicine specialty—which has long focused on standardization, cost-cutting, and consolidation—pivot to become a critical enabler in the rapid scaling of both research and clinical cellular therapies? Our hypothesis is that TMSs are ideal stakeholders working in concert to navigate this terrain and effectively increase patient access to high-quality advanced cellular therapies. Some of the challenges that the field faces to address this question are already well established. These include: the need for scalable collection infrastructure; donor safety and product stewardship; the integration of technology and informatics; sustainable funding mechanisms reflecting the true value of cell therapy services (other than the final product) such as apheresis, and the education and training of the next generation of professionals to sustain and advance the field. Each topic is discussed along with a list of questions that remain unanswered. While not exhaustive, the intent is to represent key areas where the TMS can contribute meaningfully—not only by answering them directly, but also by identifying and convening the right collaborators. Hospitals alone cannot meet the full demand for mononuclear cell collections required to treat the eligible patient population.9-13 Although most hospitals are part of a healthcare network, the infrastructure needed to collect cellular starting material (CSM) is typically concentrated in one or two locations. Often, these locations are geographically close to a center of excellence for comprehensive cancer care. A 2024 McKesson survey noted that “for most Americans who don't live near a major academic center, these innovative therapies aren't readily available, creating vast ‘CGT deserts’,”14 highlighting both geographic and systemic barriers to access. One practical way to extend access—particularly for (relatively) stable patients—is to offer care, including apheresis collection, in outpatient settings as close to the patient's community as feasible.15 However, most hospital-based apheresis teams are not mobile, and current patient volumes, combined with workforce limitations, make it impractical for remaining hospitals to build their own clinical apheresis capabilities. Unless these barriers are addressed, they will continue to limit patient access—especially in rural areas—and drive unnecessary costs of care.15 Fortunately, there are several ways that the collection of CSM by apheresis could be decentralized. In the end, one needs space; collection, testing, and/or monitoring equipment; a limited pharmacy; experienced staff; back-office support such as billing, and the appropriate quality management system.11 Hospital-based programs already possess these elements; however, some blood centers also provide these services. By working together, existing hospitals and blood center-based programs could expand patient access with a hybrid solution using resources from more than one organization. Over the last two editions, the Association for the Advancement of Blood and Biotherapies (AABB) Cell Therapy Standards Committee has worked to ensure sufficient flexibility in the standards, allowing nearly every step of the process to be provided by another party, such as a blood center or another hospital. Patients could be categorized in several ways, including: (1) the most critically ill patients being collected at the hospital, where they can benefit from the additional support. (2) collections for certain therapies consistently being performed by either the hospital or the blood center. (3) the blood center handling a set number of collections during periods of high demand, or (4) the blood center supporting collections for patients who prefer or are not able to travel to the main hospital. For geographies without existing apheresis hospital- or blood center- based infrastructure, a TMS team could oversee the collection needs of multiple hospitals and clinics within a community or across several communities, a model familiar to the transfusion medicine physician. Qualified and experience apheresis nurses could provide apheresis services in a clinician's office, at a community-based hospital (including those without large cancer care units), a mobile bus, or at one of the blood center's local fixed sites. All of these settings are challenged by workforce shortages affecting physicians, nurses, and advanced practice providers. Most blood collection facilities are built for healthy donors. Much less than 1% of blood component therapy is autologous,6 whereas 60%–70% of currently approved and late-stage pipeline CGT products are autologous-derived. If the trend of treating sicker patients with CGT continues, blood centers will need to significantly reimagine their physical space and operational capabilities, moving beyond models designed primarily for allogeneic donors. This will likely include real-time laboratory testing, pharmacy and radiology integration, central venous catheter access, and medical support for symptoms like nausea and pain during apheresis. While not feasible everywhere, this model is worth exploring in some locations. In some academic medical centers (e.g., advanced therapy centers, or simply ATCs), it is not uncommon to encounter a 6–8 week waitlist for collection, with healthier patients at risk of being delayed to prioritize more urgent cases. Prioritizing treatment for the sickest patients is a well understood practice across medicine, and it is important that this principle remain intact. However, it is also important to acknowledge that healthier individuals often have better overall outcomes—not to mention provide CSM that leads to more robust and reliable cellular manufacturing.16 Chimeric antigen receptor (CAR) manufacturing failures currently can reach 25% or higher and are linked to low CAR cell activation, poor expansion in vivo, or T-cell exhaustion.17 A recent study showed that early collection of CSM for acute lymphoblastic leukemia patients improved the chances of subsequent successful therapy.18 As the demand for more CSM collections increases, including patients who are relatively more stable than late-stage oncology patients, hospitals and blood centers can work together to optimize the outcome of a successful CSM collection and CAR infusion for all patients. Disparities to access persist. According to 2024 research, patients living 2 to 4 h from a CAR-T treatment center were nearly 40% less likely to receive therapy compared to those living within 30 min.19 Black patients were less than half as likely to receive CAR-T as white patients, and patients with more comorbidities were more likely to receive it. Expanding local collection access is key to reducing racial and geographic disparities, promoting earlier therapy initiation and improved clinical outcomes. While some patients prefer treatment at specialized ATCs, others value staying within their local community—especially when that community has an adequate healthcare infrastructure and qualified providers.20 Community-based apheresis programs, when properly equipped and staffed, offer patients an opportunity to remain close to home for cell collections, reserving travel to distant for infusion and care to their This can to and help patients to their support which are associated with better the existing physical and resources of each clinical infrastructure from the academic medical center, the collection infrastructure from the blood center, and space and clinical to support patients during and collection from a community clinical care space (e.g., hospital or result in scalable, patient access at cost This of may be critical for patients, clinical often exceed the of hospitals and collection However, it also be that in the current healthcare many stakeholders and collaborators are already likely working near full operational and the of additional As clinical biotherapies the traditional models of apheresis collection and the of community are being A opportunity in expanding patient access to of their care that not need to be performed at a center. 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