# Before You Fly: The Complete Checklist for Patients Seeking CAR-T in China > Plain-text mirror of https://chinamyeloma.org/en/car-t-treatment-in-china/checklist > Publisher: China Myeloma Digital Network (CMDN), an independent nonprofit patient advocacy platform. > Facts last reviewed: 2026-10-28 > Educational and navigation information only. Not medical advice, not an admission guarantee, and not an official price quotation. Before flying to China for commercial CAR-T, confirm an NMPA-approved product, on-site ICU with tocilizumab, written refund terms (¥100,000 / ¥300,000 retention bands), and a 8–10 week pathway with a 28–30-day Fit-to-Fly window. Treat all-inclusive packages under $150,000 as a red flag. CMDN lists 19 verification items. Related CMDN sections: [CRS, ICANS, and ICU practice](https://chinamyeloma.org/en/car-t-treatment-in-china#safety-and-risks) · [Approved commercial products](https://chinamyeloma.org/en/car-t-treatment-in-china#approved-products) · [8–10 week treatment timeline](https://chinamyeloma.org/en/car-t-treatment-in-china#treatment-timeline) · [Live cost breakdown](https://chinamyeloma.org/en/car-t-treatment-in-china/cost-comparison) · [Five discharge folders](https://chinamyeloma.org/en/car-t-treatment-in-china/discharge-handover#folders). On this page: [Safety](https://chinamyeloma.org/en/car-t-treatment-in-china/checklist#safety) · [Contracts](https://chinamyeloma.org/en/car-t-treatment-in-china/checklist#contracts) · [Continuity](https://chinamyeloma.org/en/car-t-treatment-in-china/checklist#continuity) · [Money](https://chinamyeloma.org/en/car-t-treatment-in-china/checklist#money) · [Red flags](https://chinamyeloma.org/en/car-t-treatment-in-china/checklist#red-flags). CRS and ICANS grading during the peri-infusion window follows the [ASTCT 2019 consensus](https://doi.org/10.1016/j.bbmt.2018.12.758) (Lee et al.). --- ## The 8–10 Week CAR-T Pathway at a Glance According to CMDN's Clinical Pathway (https://chinamyeloma.org/en/car-t-treatment-in-china#treatment-timeline), the treatment trajectory follows six sequential phases: | Phase & Name | Timeline & Location | Clinical Pathway & Key Milestones | | :--- | :--- | :--- | | **1. Pre-Travel Review** | Weeks 1–2 (Remote) | Remote records evaluation, target confirmation, S2 medical visa documentation. | | **2. Baseline & Apheresis** | Week 1 in China | Organ screening (cardiac, pulmonary, renal, viral); single-day T-cell leukapheresis. | | **3. Cell Engineering** | Weeks 2–4 (Lodging) | 2–4 week biomanufacturing window; outpatient monitoring; bridging therapy administered only if disease kinetics warrant. | | **4. Infusion & Inpatient** | Week 5 (7–14 Days) | Inpatient admission to a positive-pressure HEPA isolation suite; 3-day Flu/Cy conditioning; autologous CAR-T cell infusion on Day 0 with 24/7 hematology ICU standby. | | **5. Safety & CRS Window** | Weeks 6–9 (Outpatient) | Management of acute or delayed cytopenias; step-down to outpatient status upon clinical stability; mandatory 30-day post-infusion safety window & Fit-to-Fly clearance. | | **6. Discharge & Handover** | Week 10+ (Home) | Handover of certified bilingual dossier; transition to home oncologist for cytopenia and IVIG management; scheduled remote tele-visits. See https://chinamyeloma.org/en/car-t-treatment-in-china/discharge-handover#folders. | --- ## Section 1: Clinical Eligibility, Product Legitimacy & Medical Team Ensure the proposed cell therapy is officially authorized by the NMPA, matches your clinical history, and is led by an accessible, credentialed myeloma team. - [ ] **Is the CAR-T product officially NMPA-approved for commercial use?** Verify the exact brand name and pharmaceutical manufacturer. In Multiple Myeloma, commercially approved BCMA CAR-T therapies in China include Equecabtagene Autoleucel (CT103A / Fucaso®) (福可苏® (Eque-cel) / IASO Bio & Innovent Biologics) and Zevorcabtagene Autoleucel (CT053 / Saikaize®) (赛恺泽® (Zevor-cel) / CARsgen Therapeutics). Confirm that the hospital is an officially certified infusion center for that specific commercial product. - [ ] **Does your medical history match the approved indication (or is off-label approved)?** Commercial CAR-T requires strict adherence to NMPA label specifications (prior lines of therapy including proteasome inhibitors and immunomodulatory agents). If your clinical history slightly differs, confirm whether the hospital medical ethics committee has officially cleared your case for hospital-authorized use. - [ ] **Who is the lead hematologist, and can you speak with them before travel?** Insist on knowing the exact attending physician responsible for your inpatient care. Schedule a formal remote teleconsultation to review your bone marrow biopsy, cytogenetics, and disease trajectory before transferring deposits. - [ ] **What is the bridging therapy and washout strategy?** Between T-cell leukapheresis and cell infusion, there is a 2- to 4-week manufacturing window. Can your myeloma safely wait, or will you require bridging chemotherapy/targeted therapy in China to prevent rapid progression? Ensure your current medications are washed out according to protocol before apheresis. --- ## Section 2: Safety, Rescue Antidotes & Emergency Preparedness CAR-T toxicity can evolve within hours. Confirm dedicated critical care readiness and immediate, on-site antidote supply. - [ ] **Does the hospital have an on-site, accredited Hematology ICU? [ASTCT 2019]** Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) can develop within hours. Confirm that the facility has a fully dedicated, on-site ICU with physicians certified in grading and managing severe CAR-T toxicities per the ASTCT 2019 consensus guidelines [1] (Lee et al., Biol Blood Marrow Transplant; DOI: 10.1016/j.bbmt.2018.12.758). - [ ] **Are critical rescue medications (Tocilizumab) stocked on-site?** Grade 2+ CRS requires immediate intervention with Tocilizumab (Actemra, IL-6 receptor antagonist) and high-dose corticosteroids (Dexamethasone/Methylprednisolone) per standard ASTCT management algorithms [1]. Confirm that the hospital pharmacy has guaranteed, immediately accessible vials on-site, rather than relying on delayed emergency external procurement. > [!IMPORTANT] > **Immediate Antidote Availability: **Severe CRS can accelerate into hemodynamic shock if IL-6 blockade is delayed. Ensure the treating hospital verifies physical on-shelf stock of Tocilizumab before lymphodepletion begins, adhering to ASTCT toxicity management criteria [1]. - [ ] **What is the infection prophylaxis and cytopenia management protocol?** CAR-T induces prolonged cytopenias and severe B-cell aplasia / hypogammaglobulinemia. Verify that the medical team has clear protocols for routine monitoring of absolute neutrophil counts (ANC) and platelets; antimicrobial prophylaxis (PJP prevention with Trimethoprim-Sulfamethoxazole, antiviral coverage with Acyclovir/Valacyclovir, and antifungal coverage); and regular Intravenous Immunoglobulin (IVIG) replenishment. --- ## Section 3: Manufacturer Contracts & Refund Terms (Critical Protection) Because CAR-T is a personalized living drug, leading certified centers operate under binding contractual refund protections before any deposit is paid. - [ ] **Is there a full refund provision for apheresis or manufacturing failure?** Ensure the written agreement guarantees that if T-cell collection or biomanufacturing fails, you may either opt for a second collection attempt or decline and receive a 100% full refund of the drug payment. - [ ] **Is there a full refund for pre-apheresis clinical discontinuation?** Confirm that if your attending physician issues formal medical certification that clinical deterioration prevents proceeding with leukapheresis, the manufacturer provides a 100% full refund of the cell drug payment. - [ ] **Are tiered deductions clearly defined if treatment is cancelled post-apheresis?** Ensure transparent contractual terms: if cells are harvested but treatment is halted before manufacturing commences, retention is limited to ¥100,000 RMB; if custom production has commenced, retention is capped at ¥300,000 RMB to cover consumable costs, with the balance fully refunded. - [ ] **Is there a 100% refund entitlement for Out-of-Specification (OOS) products?** Verify that if the laboratory receives qualified T-cells but the final CAR-T product fails release criteria or quality release testing, you are entitled to discontinue therapy with a 100% full refund of the drug fee. --- ## Section 4: Fit-to-Fly Clearance & Continuity of Care The journey does not end at discharge. Establish verified travel clearance standards and a formalized clinical bridge to your home hematologist. - [ ] **What are the clinical criteria for your Fit-to-Fly certificate?** Long-haul flights carry significant risks of hypoxia, intracranial pressure changes, and deep vein thrombosis (DVT) in post-CAR-T patients. Most centers require a minimum observation period of 28 to 30 days post-infusion, sustained stable blood counts (Platelets ≥ 50,000/μL, Hemoglobin ≥ 8.0 g/dL, ANC ≥ 1,000/μL), absence of active fever or neurotoxicity for at least 14 days, and assistance with airline MEDIF documentation. - [ ] **Will you receive certified English summaries and raw DICOM diagnostic discs?** Demand a comprehensive English Inpatient Discharge Summary signed by the attending hematologist, detailing infusion kinetics, peak CRS/ICANS nursing logs, bone marrow aspirate/biopsy reports, multi-parameter flow cytometry / MRD assessments, and uncompressed digital DICOM discs for all PET-CT, CT, and MRI scans. - [ ] **Is there a structured handover and direct liaison channel to your home oncologist?** Who is responsible for your Day 30, Day 90, Day 180, and Day 360 (1-Year) evaluations? Ensure your Chinese attending physician provides an official direct communication channel (department email or direct physician-to-physician memo) to brief your local oncologist on monitoring delayed cytopenias, secondary hypogammaglobulinemia, and IVIG maintenance. --- ## Section 5: Financial Transparency, Visas & Living in China Evaluate comprehensive medical and non-medical expenses, institutional wire protections, visa extension logistics, and daily infection-safe living. - [ ] **Is the quote all-inclusive, and does it align with official drug pricing and hospital tier reality?** Verify that quotes separate the commercial drug from hospital care. Commercial cell products are officially priced in RMB: 赛恺泽® (Zevor-cel) carries a list price of ¥1,150,000 with a current ¥200,000 international patient reduction bringing net drug cost to ¥950,000; 福可苏® (Eque-cel) list price is ¥1,166,000. CMDN China CAR-T Cost Benchmarks differ between public general wards (¥80,000–¥220,000), public international medical centers (¥150,000–¥350,000), and private international hospitals (¥350,000–¥500,000). Hospital-side ranges represent the CMDN Public-Tariff & Clinical Cost Benchmark—compiled from published municipal tertiary hospital fee schedules and standard 7–14-day peri-infusion clinical pathways. They cover work-up, apheresis, Flu/Cy lymphodepletion, inpatient isolation monitoring, supportive medicines, and early follow-up. Because Chinese hospitals bill itemized actuals rather than fixed all-in packages, bridging therapy, ICU escalation, and travel/living costs are budgeted separately. Compare those figures against the CMDN live cost breakdown. Peri-infusion HEPA isolation typically spans 7–14 days, followed by outpatient observation. Confirm on-site ICU readiness and pharmacy stock to avoid emergency external procurement. - [ ] **Does the hospital support cross-border government subsidies and international insurance reimbursement?** Several foreign governmental health programs and private insurers offer cross-border medical subsidies. Verify that the Chinese hospital has administrative workflows to provide a formal Prior Authorization Medical Dossier with standard ICD-10 C90.0 coding, a Medical Necessity Statement, and official institutional stamping on overseas reimbursement claim forms. - [ ] **Is payment made via institutional wire with an official tax invoice (Fapiao)?** Payments must be wired via SWIFT directly to the hospital official institutional bank account. Never transfer funds to personal accounts or unverified facilitators. Ensure the hospital issues an Official Chinese Tax Invoice (发票 Fapiao) alongside an itemized English medical bill, which is mandatory for insurance reimbursement and tax filing. - [ ] **Can the hospital provide official S2 medical visa extension support?** International patients enter on an S2 Medical Visa. Because the full pathway spans 8–10 weeks (and longer if marrow recovery requires observation), ensure the hospital International Medical Department has official accreditation to issue medical invitation letters and provide in-person documentation to the local Public Security Bureau (Exit-Entry Administration) if an extension is required. - [ ] **Are daily living, infection-safe dining, and medical translation secured?** During post-infusion neutropenia, food must be freshly cooked and microbiologically safe (Neutropenic Diet). Confirm whether the hospital provides compliant meals or whether hospital-adjacent serviced apartments offer sterile cooking facilities. Verify dedicated English medical coordination during daily rounds and emergencies. --- ## Standard Manufacturer Written Contract Terms to Verify > [!NOTE] > These are terms to demand in the written manufacturer / hospital supply agreement before any deposit. They are reported from selected accredited international programs and are not a published, universal policy for both commercial products or every hospital. Ask the treating hospital to confirm each term in writing. ### Apheresis or Manufacturing Failure - **Trigger condition**: T-cell harvesting fails to gather adequate viable lymphocytes, or laboratory cell engineering fails quality release. - **Contractual refund protection**: A second harvesting or production run is typically offered upon clinical evaluation. If you decline a second attempt, or if the repeat run still fails, the manufacturer provides a 100% full refund of the drug payment. ### Pre-Apheresis Clinical Discontinuation - **Trigger condition**: The attending hematologist certifies that the patient clinical condition has deteriorated (e.g., organ decompensation or rapid myeloma crisis) rendering leukapheresis clinically unsafe. - **Contractual refund protection**: Upon receipt of formal hospital medical certification, the manufacturer provides a 100% full refund of the cell drug payment. ### Post-Apheresis Voluntary or Clinical Cancellation - **Trigger condition**: T-cells have been successfully harvested, but treatment cannot proceed due to subsequent medical changes (e.g., severe refractory infection) or personal decisions before infusion. - **Contractual refund protection**: Tiered deduction applies: If cell production has NOT yet commenced, the manufacturer retains an administrative fee of ¥100,000 RMB and refunds the balance. If custom biomanufacturing has already started, the manufacturer retains ¥300,000 RMB to cover bio-reagents, and refunds the remaining balance. ### Out-of-Specification (OOS) Release Failure - **Trigger condition**: The manufacturing facility receives qualified starting cells, but the final autologous product fails NMPA release criteria or sterility tests. - **Contractual refund protection**: The patient is entitled to discontinue the protocol with a 100% full refund of the drug fee. --- ## Red flags in China CAR-T quotes and facilitators 1. **"All-Inclusive Private Packages" Under $150,000**: The legitimate commercial cell drug alone starts at about ¥950,000 before any hospital care. Any intermediary offering a private hospital package with luxury lodging and translation below $150,000 cannot mathematically cover authentic commercial product manufacturing and licensed inpatient HEPA care. 2. **Promises of a "100% Cure"**: CAR-T delivers deep, durable remissions, but relapsed/refractory multiple myeloma remains a complex disease. No credentialed hematologist guarantees a permanent cure. 3. **Requests for Wire Transfers to Personal or Third-Party Accounts**: Legitimate Chinese tertiary hospitals and licensed pharmaceutical distributors only accept payments via official institutional bank accounts with matching tax invoices. 4. **Outpatient or Non-ICU Infusions**: CAR-T must never be infused in an outpatient clinic or a facility lacking an on-site, 24/7 accredited intensive care unit. 5. **Vague or Refused Refund Contracts**: If a facility or facilitator refuses to provide the manufacturer written, tiered cancellation and refund terms before deposit payment, terminate discussions immediately. 6. **Claims of "Free Clinical Trials for Foreign Tourists"**: Official registered clinical trials in China operate under strict Human Genetic Resources (HGRAC) regulations and longitudinal follow-up mandates, rendering them inaccessible to short-term foreign visitors. Such claims frequently represent unauthorized procedures. --- ## Frequently asked questions ### What should I verify before flying to China for CAR-T? CMDN's pre-travel checklist has 19 items covering product legitimacy, on-site ICU and tocilizumab stock, written manufacturer refund terms, Fit-to-Fly clearance, and how the quote splits drug versus hospital care. Confirm an NMPA-approved commercial product and a named hematologist before you transfer any deposit. ### What refund terms belong in a China CAR-T drug contract? Ask for written terms covering apheresis or manufacturing failure (typically a full drug-fee refund), pre-apheresis clinical stop (full refund with hospital certification), post-apheresis cancellation with tiered retention of ¥100,000 if manufacturing has not started or ¥300,000 if it has, and a 100% refund if the product fails release testing. These are terms to demand in the written manufacturer / hospital supply agreement before any deposit. They are reported from selected accredited international programs and are not a published, universal policy for both commercial products or every hospital. Ask the treating hospital to confirm each term in writing. ### How do I spot a fake all-inclusive CAR-T package in China? The cheaper of the two commercial cell products still nets about ¥950,000 before any hospital care. A third-party “all-inclusive private package with lodging and translation” under $150,000 cannot cover authentic manufacturing plus licensed HEPA inpatient care. Ask which licensed product the quote is based on, which hospital account receives the wire, and what is included besides the drug. ### Do licensed Chinese CAR-T centers have tocilizumab and an on-site ICU? Licensed hematology centers administering commercial CAR-T are expected to operate an on-site ICU with 24/7 coverage and to stock tocilizumab (an IL-6 receptor antagonist) plus corticosteroids for CRS. Confirm physical on-shelf tocilizumab before lymphodepletion; do not accept a plan that relies on delayed external procurement or an outpatient infusion without ICU backup. ### How long is the international CAR-T pathway in China, including Fit-to-Fly? The typical commercial pathway is 8–10 weeks, including 2–4 weeks of cell manufacturing and a 7–14-day peri-infusion isolation stay. Fit-to-Fly clearance is typically issued after a 28–30-day post-infusion safety window, with the bilingual certificate stamped close to departure. --- ## Institutional Notice & Related Resources China Myeloma Digital Network (CMDN) is an independent non-profit patient advocacy organization. CMDN does not hold patient funds or set medical prices. All medical evaluations, treatment protocols, and formal invoices are issued directly by licensed treating hospitals. - Companion Discharge Handover Guide: https://chinamyeloma.org/en/car-t-treatment-in-china/discharge-handover - Commercial Pricing Breakdown: https://chinamyeloma.org/en/car-t-treatment-in-china/cost-comparison - Main CAR-T Portal: https://chinamyeloma.org/en/car-t-treatment-in-china - Ask CMDN for guidance: https://chinamyeloma.org/en/car-t-treatment-in-china#inquiry-form