Late toxicities and surveillance strategies after anti-CD19 and anti-BCMA CAR-T cell therapy

Chimeric antigen receptor T‑cell (CAR-T) therapy has revolutionized the treatment of hematologic malignancies. While early adverse events such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are well-documented, late-onset toxicities are increasingly recognized as significant challenges affecting patient morbidity and survival. These include B‑cell-aplasia with hypogammaglobulinemia, prolonged cytopenias, infections, neurocognitive complications, hemophagocytic lymphohistiocytosis-like syndromes (IEC-HS), and secondary malignancies. Recent data from clinical trials and real-world evidence highlight the necessity for a structured long-term surveillance strategy. This review summarizes current evidence regarding CAR-T-related late toxicities and outlines practical recommendations for posttreatment monitoring.