Abstract
CAR-T cell therapy revolutionized the treatment of patients with relapsed or refractory B-cell hematologic malignancies, substantially altering their prognosis. Alongside its remarkable efficacy, however, this approach is frequently accompanied by treatment-related toxicities. While cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) are the best characterized and usually manageable with standard interventions, a spectrum of additional, non-canonical complications has gained increasing clinical recognition. These include persistent cytopenias (immune effector cell–associated hematologic toxicity, ICAHT), immune effector cell–associated hemophagocytic lymphohistiocytosis–like syndrome (IEC-HS), and coagulopathies. Such events may manifest late, persist for prolonged periods, and significantly compromise patients’ quality of life. In this manuscript, we summarize current evidence and guideline-based recommendations regarding these non-canonical complications, with the aim of providing clinicians a practical framework for their recognition, management, and integration into routine post-infusion care.
Keywords
Chimeric antigen receptor T-cell, Cytokine release syndrome, Immune effector cell-associated neurotoxicity, Non-canonical toxicity, Immune effector cell -associated hematologic toxicity, Immune effector cell -associated hemophagocytic lymphohistiocytosis- like syndrome, Coagulopathy