Complications of Car-T Cell Therapy in Hematologic Malignancies — A Current Clinical Review of Toxicities and Management Strategies

Chimeric antigen receptor T-cell (CAR-T) therapy represents an innovative treatment for relapsed or refractory hematologic malignancies, such as acute lymphoblastic leukemia and diffuse large B-cell lymphoma. Despite its significant clinical efficacy, CAR-T therapy is associated with a spectrum of toxicities resulting from the activation of the immune system. This review summarizes current understanding of the mechanism, clinical presentation, and management of CAR-T–related complications. Particular attention is given to cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), hematologic toxicities, and infectious complications, as well as long-term effects such as B-cell aplasia and hypogammaglobulinemia. Additionally, predictive biomarkers, such as inflammatory markers, cytokine profiles, and CAR-T expansion kinetics, are examined in relation to risk stratification and early treatment strategies. Understanding these mechanisms is necessary to improve patient safety and optimize clinical outcomes. In conclusion, although CAR-T therapy is a significant progress in hemato-oncology, additional research is required to improve toxicity prediction models and develop safer, next-generation cellular therapies.