Operational Challenges and Collaborative Strategies for Outpatient Cellular Therapy: Insights From Zahra Mahmoudjafari, PharmD, BCOP, FHOPA

Pharmacy Times® interviewed Zahra Mahmoudjafari, PharmD, BCOP, FHOPA, on her presentation on the logistical and operational challenges of delivering cellular therapies in the outpatient setting at the 2025 American Society for Transplantation and Cellular Therapy (ASTCT) and Center for International Blood and Marrow Transplant Research (CIBMTR) Tandem Meeting in Honolulu, Hawaii. Mahmoudjafari discussed key considerations for outpatient delivery, including ensuring multidisciplinary team involvement, effective communication, and the development of standard operating procedures.

Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA, is a clinical pharmacy manager in the Blood and Marrow Transplant Program in the Division of Hematologic Malignancies and Cellular Therapeutics at the University of Kansas Cancer Center in Kansas City, Kansas. Mahmoudjafari is a board-certified oncology pharmacist involved in several oncology-pharmacy organizations, such as the Hematology/Oncology Pharmacy Association (HOPA), currently serving as secretary on the HOPA board of directors. She has also been the chair or cochair of conferences such as Advanced Topics for Oncology
Pharmacy Professionals and Oncology Pharmacists Connect. In 2022, she was the recipient of the American Society for Transplantation and Cellular Therapy Pharmacy Special Interest Group Lifetime Achievement Award and received the American Society of Clinical Oncology’s 40 Under 40 in Cancer Award.

Mahmoudjafari has presented nationally on her experience with managing high cost therapies and on clinical topics such as cell and gene therapies, acute and chronic graft-vs-host disease, and the management of fungal infections in hematopoietic stem cell transplantation. Mahmoudjafari completed her pharmacy training at the University of Missouri-Kansas City (UMKC) and her PGY-1 pharmacy practice residency at The Ohio State University Wexner Medical Center. She completed her PGY-2 oncology residency at Huntsman Cancer Institute at the University of Utah and most recently received her MBA from Henry W. Bloch School of Management, which is affiliated with UMKC.

To maximize pharmacist contributions, Mahmoudjafari highlights the importance of strong relationships with not only clinical providers but also financial teams, quality teams, and those involved in cell processing. Pharmacists can also help to address health disparities by providing education to patients and caregivers, ensuring proper medication reconciliation, monitoring for drug interactions, and supporting long-term patient monitoring. Pharmacists also play a role in ensuring the accuracy of orders and addressing any complications in the short-term post-treatment phase, according to Mahmoudjafari.

Finally, Mahmoudjafari encourages pharmacists to actively engage in sharing knowledge and seeking guidance from peers to continuously improve care delivery in the evolving field of cellular therapy.

Pharmacy Times: What are common logistical or operational challenges in safely delivering cellular therapies in outpatient settings?

Zahra Mahmoudjafari, PharmD, BCOP, FHOPA: There are several logistical and operational challenges when it comes to safely delivering cell therapies in the outpatient setting, and it really involves individuals within the multidisciplinary team. I can't stress this enough that it requires really a representative from every team to make this a success, and making sure that we have multidisciplinary meetings, regularly scheduled meetings to discuss different ways that these therapies should flow through a clinic. I think I probably have 13 different physio workflows that I worked on to ensure success just at my center alone, and we continue to make tweaks as we learn more and more about the program.

I would say the first is operational consideration when it comes to making sure that you've identified your key stakeholders and then ensuring that those key stakeholders are then communicating back with their team. Now, of course, there comes making sure that you have standard operating procedures and a method of reviewing from a quality perspective as well.

Now then, from an operational consideration, how often or how long is your clinic open for? What are the pathways for admission? Are there ways that you can incorporate some electronic medical record support to make this as easy as possible? And then lastly, there's also financial considerations that you have to [consider] before you can transition these therapies to the outpatient setting. Of course, financial reimbursement is different between inpatient and outpatient. So oftentimes that group of folks may be forgotten about in the clinical team, but it's really important to keep those individuals in mind as well.

Pharmacy Times: Are there specific interprofessional collaboration strategies you've seen that maximize pharmacist contributions to the cellular therapy team?

Mahmoudjafari: So, there are several. Of course, we're very fortunate in the hematology and blood marrow transplant space that many of the pharmacists already have very positive and collaborative relationships with their provider teams. So, for sure, the physicians, the nurse practitioners, and nurses are some very important individuals that you want to make sure you have good relationships with. But then, in addition to that, you're also hoping to have relationships with the financial teams as well as the quality teams, not to mention apheresis and cell processing. So, there are a couple of other members of the team that you want to make sure the pharmacist is looped in with.

There is a strong element of case management and social work when patients are managed on the outpatient setting to make sure that they have the appropriate caregiver support, etc, to ensure their success. And so, there are a lot of individuals that you want to make sure that a pharmacist has a really strong working relationship with to make sure that these patients are ultimately able to be successful outpatient.

An artificial intelligence depiction of embryonic stem cells. Image Credit: © Billy - stock.adobe.com

Pharmacy Times: What role can pharmacists play in addressing health disparities related to outpatient cellular therapy treatment?

Mahmoudjafari: There are so many different roles, whether you work in a setting where you're in more of a quality role [where] you're monitoring these patients and you're wanting to impact the overall process, or if you're in more of a direct patient care setting, where you are completing medication reconciliation, you are reviewing patients’ other medications, and ensuring that there aren't any drug-drug interactions or anything that needs to be adjusted as a result of their medications. A huge role that the pharmacists play are the education to both the patient themselves and then really specifically the caregivers, because the onus of monitoring these patients ultimately does fall on that caregiver and making sure that the caregiver knows who to contact and how to contact [them] in an appropriate manner.

There's also a role of the pharmacist as it relates to making sure that the appropriate orders are entered and verified, and then you go into more of the short term monitoring. As we learn more and more, the long term monitoring is proving to be really impactful as well. So, there's lots of opportunity for pharmacists here.

Pharmacy Times: What emerging trends in cellular therapy should pharmacists be prepared for over the next few years?

Mahmoudjafari: There are so many moving parts. I can definitely foresee an additional push, or more and more of a trend to manage these patients safely on the outpatient side. I think that that can easily be done with the appropriate infrastructure, and hopefully our talk and presentation at the ASTCT and CIBMTR Tandem meeting will provide some additional insight there.

Certainly, a trend in that direction of more outpatient care likely, and I'm hoping, fingers crossed, that we'll see more innovative strategies such as remote patient monitoring, ways that we can minimize the patient's time spent in clinic or coming in inpatient for their care.

You also see an additional trend clinically in terms of cell therapies in oncology disease states, as well as cell therapies in non-oncology disease states that require the expertise of a blood and bone marrow transplant pharmacist. So, there are a lot of different trends, it just kind of depends on which rabbit hole you want to go down right now. But related specifically to this presentation, I can only continue to predict more trends toward the outpatient setting.

Pharmacy Times: What resources or training opportunities would you recommend for pharmacists who want to expand their expertise in outpatient cellular therapy delivery?

Mahmoudjafari: There have been several publications over the course of the last several years that have demonstrated insights into how different centers have established and maintained their outpatient programs. So, I always reference those whenever I'm looking at improving our own program here. Certainly, there are publications in the Transplantation and Cellular Therapy journal. There are other publications that can easily be found through resources like PubMed, as well as presentations like this.

I think it's completely invaluable to reach out to colleagues and ask them for their expertise and their opinion. I definitely have done that, reaching out to colleagues across other centers to see how they've done it, and then used their method and approached it and adapted it to what works here at my center.

So, it has been a learning process. We continue to evaluate what that process looks like for our patients and adapt to the trends. There are some baseline foundational resources available, but there's nothing more valuable than reaching out to a colleague directly and just having that conversation.