Emerging Patterns of Delayed CAR T-Cell Therapy Toxicities
Key Clinical Summary
- Expanding Role of CAR-T Therapy: As CAR T-cell therapy becomes a central component of hematologic malignancy treatment, understanding and managing its broad toxicity spectrum is increasingly critical.
- Acute vs Delayed Toxicities: Acute effects such as CRS, neurotoxicity, and cytopenias are typically managed at CAR-T centers, while delayed toxicities—including cranial nerve palsies, Parkinsonian movement disorders, colitis, and prolonged cytopenias—require ongoing community-based monitoring and early intervention.
- Monitoring and Mitigation: Early and rapid ALC (absolute lymphocyte count) expansion may help reduce late toxicity risk; continuous neurotoxicity surveillance and prompt recognition of delayed immune-mediated effects are key to improving long-term CAR-T safety and patient outcomes.
Adriana Rossi, MD, Mount Sinai School of Medicine, New York, New York, discussed the management of CAR T-cell therapy toxicities, emphasizing the need for vigilance in recognizing both acute and delayed effects on patients as CAR T-cell therapy use expands at the 2025 Lymphoma, Leukemia & Myeloma (LL&M) Congress in New York, New York.
She highlighted the importance of community providers continuing to monitor patients for late complications such as movement disorders, colitis, and prolonged cytopenias.
Dr Rossi concluded, “But more and more as these patients transition back out to the community, identifying, monitoring and early intervention for the delayed toxicities is becoming increasingly important.”
Transcript:
Hi, I'm Adriana Rossi. I'm the director of the CAR-T and Stem Cell program for multiple myeloma at Mount Sinai here in New York and I am enjoying the LL&M conference in New York today.
I had the opportunity to give a wonderful talk reviewing the toxicities of CAR-T therapies and as CAR-T will become bigger and bigger part of the way we treat our hematologic malignancies, we are learning new and new toxicities.
There are certainly the acute toxicities, including CRS and the neurotoxicities and the low blood counts. Those most of the time will be taken care of at the CAR-T center. But more and more as these patients transition back out to the community, identifying, monitoring and early intervention for the delayed toxicities is becoming increasingly important.
We highlighted how things like an early and rapid expansion of the ALC could be an opportunity for us to mitigate and decrease the risk of these late toxicities and the early monitoring specifically for neurotoxicities, including cranial nerve palsies, the Parkinsonian movement disorders, the new signal that we're recognizing of colitis, which really can happen months after the infusion, and the prolonged cytopenias and interventions available for that.
Source:
Rossi A. Managing Toxicities of T-Cell Directed Therapies. Presented at Lymphoma, Leukemia & Myeloma Congress; October 14-17, 2025. New York, NY.
