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

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.