Adoptive cellular therapy has made a landmark change within the treatment paradigm of several hematologic malignancies, and novel cellular therapy products, such as chimeric antigen receptor T‐cell therapy (CART), have demonstrated impressive efficacy and produced durable responses. However, the CART treatment process is associated with significant toxicities, healthcare resource utilization, and financial burden. Most of these therapies have been administered in the inpatient setting due to their toxicity profile. Improved toxicity management strategies and a better understanding of cellular therapy processes are now established. Therefore, efforts to transition CART to the outpatient setting are warranted with the potential to translate into enhanced patient quality of life and cost savings. A successful launch of outpatient CART requires several components including a multidisciplinary cellular therapy team and an outpatient center with appropriate clinical space and personnel. Telemedicine should be incorporated for closer monitoring. Additionally, clear criteria for admission upon clinical decompensation, a pathway for prompt inpatient transition, and clear toxicity management guidelines should be implemented. Effective education about cellular therapy and toxicity management is imperative, especially for the Emergency Department and Intensive Care Unit teams. Here, we have outlined the various logistical and clinical considerations required for the care of CART patients, which will aid centers to establish an outpatient CART program.

The Amazon River shrimp Macrobrachium amazonicum is widely distributed throughout South America, is amply exploited by artesian fisheries, and shows elevated potential for aquaculture investment: To establish the lethal critical concentration of total ammonia and nitrite after 96 h (LC 50-96 h). Adult shrimps were collected from the Rio Grande River, state of Minas Gerais, Brazil, near the Água Vermelha Dam. Individual shrimps (N=10) were exposed to 7 concentrations of ammonium chloride (30, 60, 120, 170, 200, 250 or 300 mg.L-1) for 96 h or 5 concentrations of sodium nitrite (20, 30, 40, 50 or 60 mg.L-1). Six replicate experiments were performed. The LC 50 after 96 h exposure was calculated using a Probit analysis, and was adjusted employing a linear regression (P≤0.05). The LC 50 calculated after 96 h exposure of M. amazonicum was 54.27 mg.L-1 total ammonia or 30.75 mg.L-1 nitrite. Based on these findings we recommend a safe level of 5.427 mg.L-1 total ammonia and 3.075 mg.L-1 nitrite for aquaculture production. Intraspecific genetic and physiological variation among M. amazonicum populations may explain the difference in LC 50-96 h seen between the shrimp population cultivated in the Rio Grande River and those cultivated at other facilities.

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