CAR-T Safety Profiles: Clinical Approaches to Toxicity Management in 3L R/R LBCL

The management of CAR T-cell therapy toxicities has evolved significantly, with early complications such as cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome now more aggressively treated using a range of interventions, including steroids and immunomodulatory agents. These adverse effects typically occur during the initial phase of treatment and are closely monitored at specialized centers equipped for rapid response, including intensive care unit-level care when needed. However, once the acute phase passes and the patient is discharged, the risk of late complications remains. Continued monitoring, especially in partnership with community providers, is essential to track immune recovery, manage infection prophylaxis, and address lingering cytopenias.

Posttreatment care involves a structured approach to ensure patient safety beyond the CAR T center. Coordination with referring physicians includes detailed documentation of the patient’s course and the rationale for ongoing therapies such as antifungal or antiviral prophylaxis. Follow-up protocols also include checking immunoglobulin levels, assessing the need for intravenous immunoglobulin, and ensuring that vaccinations are administered at the appropriate time. For patients experiencing delayed count recovery, growth factor support or transfusions may be necessary, and in some cases, bone marrow evaluation is warranted to rule out secondary disorders.

Real-world data have become increasingly influential in shaping treatment decisions for CAR T-cell therapy. While randomized trials offer controlled comparisons, they often exclude patients with comorbidities or complex disease presentations. In contrast, real-world evidence reflects outcomes in diverse populations seen in everyday practice. Encouragingly, these data confirm that patients with additional health challenges often experience outcomes comparable to those seen in trials. They also reveal valuable insights into toxicity management and extend the evidence base to include underrepresented subtypes and patient populations, reinforcing the therapy’s broader applicability and curative potential.