REVIEW ON THE EXPANDING ROLE OF CAR-T THERAPY FROM HEMATOLOGICAL CANCER TO AUTO IMMUNITY

Abstract: N Chimeric Antigen Receptor T-cell (CAR-T) therapy represents a significant advancement in cancer immunotherapy, utilizing
genetically modified T lymphocytes that express synthetic receptors designed to recognize specific tumor-associated antigens. These
engineered immune cells combine antibody-like specificity with T-cell cytotoxic functionality, enabling targeted elimination of malignant
cells. The clinical significance of this approach has been validated through FDA approval of multiple CAR-T therapeutics, including
tisagenlecleucel (Kymriah) for B-cell acute lymphoblastic leukemia (B-ALL) and axicabtagene ciloleucel (Yescarta) for diffuse large B-cell
lymphoma (DLBCL). Current CAR-T applications predominantly target hematological malignancies through recognition of lineage-specific
surface markers including CD19, CD20, CD22, and B-cell maturation antigen (BCMA). These targets have demonstrated clinical efficacy
due to their restricted expression patterns and accessibility to circulating CAR-T cells. Recent investigational applications have expanded
beyond oncology to address autoimmune pathologies, where CAR-T cells can be engineered to target autoreactive B-cells or pathogenic
plasma cells implicated in conditions such as systemic lupus erythematosus, myasthenia gravis, and refractory autoimmune cytopenias.
Despite promising clinical outcomes, CAR-T therapy faces substantial challenges including potentially severe immune-related adverse
events such as cytokine release syndrome and neurotoxicity, which require specialized monitoring and management protocols. Additional
limitations include manufacturing complexity, substantial production costs, and variable persistence of therapeutic cells, factors that
collectively restrict broader clinical implementation.