[CAR T-cell therapy of mature B-cell neoplasms-Current use and practical considerations]

Chimeric antigen receptor (CAR) T‑cell therapy represents a novel and highly effective immunotherapeutic approach in the treatment of malignant B‑cell neoplasms. Although the term B‑cell non-Hodgkin's lymphoma (B-NHL) is still frequently used in clinical practice, the pathologically accurate designation according to the 2022 World Health Organization (WHO) classification is mature B‑cell neoplasms. The use of CAR T‑cell therapy is currently approved for several subtypes of these diseases, including large B‑cell lymphoma (LBCL), primary mediastinal B‑cell lymphoma (PMBL), mantle cell lymphoma (MCL) and follicular lymphoma (FL). The approach involves the ex vivo genetic modification of autologous T‑cells to express a CAR targeting the B‑cell surface antigen CD19, enabling the selective elimination of malignant CD19-positive cells. Clinical studies and register data have demonstrated a high overall response rate, significant improvements in progression-free survival (PFS) and sometimes also in overall survival (OS) in the varíous lymphoma entities. Despite these promising results, CAR T‑cell therapy remains complex and requires careful selection of the indications and specialized management of associated toxicities. Typical, but mostly manageable side effects of CAR T‑cell therapy include cytokine release syndrome (CRS), neurotoxicity (immune effector cell-associated neurotoxicity syndrome, ICANS), hematotoxicity (immune effector cell-associated hematotoxicity, ICAHT) and protracted immune reconstitution leading to increased susceptibility to infections. Close collaboration between CAR T‑cell centers and institutions that are not CAR T‑cell certified or practices is essential for the success of treatment. This affects not only the appropriate indications and the selection of an optimal bridging therapy prior to CAR T‑cell infusion but also particularly the structured management of potential complications during the postoperative course, in particular infectious complications, which frequently occur in the outpatient setting. Early communication, clear responsibilities and standardized follow-up protocols are decisive to ensure safe and successful care after CAR T‑cell therapy.