Systemic complications of (Chimeric Antigen Reoeptor T-Cell therapy) CAR-T cell therapy: What internal medicine specialists should recognize and manage.

Abstract

Objective: To integrate current evidence on systemic complications of CAR-T therapy that are most pertinent to internal medicine physicians, specifically regarding recognition, differentiation, early stabilisation, and co-management in the wards and intensive care units. Study Design: Evidence Acquisition (Secondary Search, 202026). Setting: PubMed/MEDLINE and Google Scholar were used as sources of secondary literature review of studies published. Period: January 2020 and December 2026. Methods: The search terms consisted of the combination of the terms CAR-T, chimeric antigen receptor, toxicity, cytokine release syndrome, ICANS, infection, cardiotoxicity, coagulopathy, and tumour lysis syndrome. Priority was given to clinical guidelines, consensus statements, systematic reviews, and large observational studies. Case reports and strictly preclinical studies were excluded. Results: The most frequent acute complications are The most frequent acute complications are typically early hyperinflammatory toxicities, including CRS and ICANS. Subsequent risks include infections associated with cytopenias and B-cell aplasia, hematologic/coagulation disorders, metabolic emergencies such as TLS, acute kidney injury, and cardiopulmonary instability. Other conditions that are not common but are severe in nature, including hemophagocytic lymphohistiocytosis-like hyperinflammation, demand extra attention. Conclusion: Internal medicine specialists are considered to be crucial in the early detection and stabilisation of systemic complications in CAR-T. Time-dependent patterns of toxicity, systematic assessment plans, and escalation levels are familiarity requirements that should optimise outcomes in the high-risk population.