Loading
A patient's T cells are removed, given a synthetic receptor that recognises the cancer, multiplied, and put back as a living drug.
Seven approved autologous products: CD19 (tisagenlecleucel, axicabtagene, lisocabtagene, brexucabtagene, obecabtagene) and BCMA (idecabtagene, ciltacabtagene). Curative in a substantial fraction of relapsed large B-cell lymphoma and ALL; moving to second line and earlier in myeloma (CARTITUDE-4). Solid tumours: CLDN18.2 (satri-cel), GPC3, GD2 (neuroblastoma, glioma), B7-H3, IL13Rα2, and regionally delivered CARs. FDA removed REMS requirements in 2025; secondary T-cell malignancy warning added in 2024.
The design is Israeli in origin: Gross, Waks and Eshhar at the Weizmann Institute of Science built the first chimeric receptor in 1989, splicing antibody variable domains onto T-cell receptor constant domains so that a T cell killed its target without the major histocompatibility complex presenting it. They called it a T-body; costimulatory domains, the scFv format and the manufacturing came later.
T cells are transduced with a lentiviral or retroviral chimeric antigen receptor (scFv + costimulatory domain + CD3ζ), infused after lymphodepletion, and expand in vivo.
Dependencies are what this technology cannot be delivered without: manufacturing steps, instruments, software, upstream methods. See its full chain on the map.
Anitocabtagene autoleucel is a BCMA CAR-T whose binder is a small synthetic D-domain protein rather than an antibody fragment, a design chosen for low immunogenicity. In heavily pretreated myeloma it produced responses in 97% of patients with mostly low-grade cytokine release syndrome and no delayed parkinsonism reported, and an FDA decision is due on 27 December 2026.
A CD19 CAR-T that cures about 40% of patients with large B-cell lymphoma who had failed everything, and beat transplant in second line.
Brexucabtagene autoleucel is the CAR-T therapy for mantle cell lymphoma and adult acute lymphoblastic leukaemia, giving long remissions after BTK inhibitors fail.
Ciltacabtagene autoleucel is a one-time BCMA CAR-T for myeloma that, in CARTITUDE-4, cut the risk of death by about 45% compared with standard regimens.
Cyclophosphamide is an alkylating chemotherapy that damages DNA in dividing cells. It is part of CHOP for lymphoma, AC for breast cancer and VAC for childhood sarcomas, clears lymphocytes before CAR-T and prevents graft-versus-host disease after transplant; bladder bleeding, infertility and secondary leukaemia are its harms.
Emapalumab switches off interferon gamma, the signal behind the runaway immune activation of haemophagocytic lymphohistiocytosis (HLH), a condition that can also be triggered by lymphoma and by CAR-T therapy.
Equecabtagene autoleucel is a BCMA CAR-T from IASO Bio and Innovent, approved in China in June 2023 for multiple myeloma that has returned after at least three lines of treatment. In the FUMANBA-1 trial about 96% of infused patients responded, most with deep minimal-residual-disease-negative remissions and few severe cytokine release reactions; it competes with cilta-cel and zevor-cel in China.
Fludarabine is a chemotherapy infusion for chronic lymphocytic leukaemia. It anchored the FCR regimen that was the first to give long remissions, and today it is used above all to prepare patients for CAR-T cells and transplants.
Idecabtagene vicleucel was the first myeloma CAR-T (2021) and is now approved after two prior lines based on KarMMa-3.
Inati-cel is a Chinese CAR-T for adults with acute lymphoblastic leukaemia that has come back or stopped responding, approved in 2023.
Lisocabtagene maraleucel is the only CAR-T approved for chronic lymphocytic leukaemia, for patients whose disease has outrun both BTK and BCL-2 inhibitors.
NXC-201 CAR-T is an experimental CAR-T cell therapy from Nexcella in phase 2 trials, aimed at BCMA.
A CD19 CAR-T built to grip and release quickly, which cut severe side effects and gave adults with relapsed ALL a real chance at durable remission.
Relma-cel was the first CAR-T therapy developed and made in China to be approved, for large B-cell lymphoma that has come back after two treatments.
Satricabtagene autoleucel (satri-cel) is the first CAR-T therapy approved for a solid tumour (gastric cancer), in China.
India's first home-grown CAR-T cell therapy, approved in 2023 for relapsed leukaemia and lymphoma, made in Mumbai for roughly a tenth of what the same kind of treatment costs in the US.
Tisagenlecleucel was the first CAR-T therapy ever approved (2017), for children and young adults whose leukaemia had come back after everything else.
Tocilizumab (Actemra) is a rheumatoid arthritis antibody that has become the rescue drug for cytokine release syndrome, the fever and blood-pressure crash that CAR-T cells and bispecific antibodies can trigger. Every CAR-T centre must have it on hand.
India's second approved CAR-T therapy, a Bengaluru-made version of a Spanish hospital's academic CD19 cell therapy, for lymphoma that has come back after other treatments.
Zevor-cel is CARsgen's myeloma CAR-T, approved in China in 2024 for patients whose disease has come back after three or more treatments.
This is the trial behind the first approval of a CAR-T therapy for a solid tumour, in China. The gain in progression-free survival is real but measured in weeks, 15 percent of patients randomised to satri-cel never received it, and nearly every treated patient had cytokine release syndrome, so the trade-off is very different from CAR-T in blood cancers. Overall survival is not reported in the abstract.
A lower-middle-income country can design, manufacture, trial and approve an autologous CAR-T therapy. Response rates are in the range of first-generation Western products in similar mixed populations, at a price an order of magnitude lower, which reopens the question of what CAR-T should cost everywhere.
CARTITUDE-4 is the first randomised trial to show that a CAR-T improves survival in myeloma, and it moved cilta-cel into second-line use (FDA approval 2024). For patients whose disease returns after first-line lenalidomide, a one-off cell therapy now competes with continuous drug combinations. Capacity, cost and the need for bridging therapy still limit who actually receives it.
The clinical result is in line with commercial BCMA CAR-T products, but the point of the paper is the manufacturing: an academic hospital produced its own CAR-T cells, infused them fresh and treated patients who would otherwise wait for a commercial slot. It is the evidence base for what Immix Biopharma now develops as NXC-201.
KarMMa-3 was the first randomised evidence that CAR-T beats conventional drugs in myeloma and led to ide-cel's approval after two prior lines. It confirmed that earlier use of CAR-T produces deeper and longer remissions than in the end-stage setting. Because responses are shorter than with cilta-cel and OS was not improved, it also sharpened debate about which BCMA CAR-T to use and when.
Axicabtagene ciloleucel as an option in relapsed follicular and marginal zone lymphoma. Compared with tisagenlecleucel in ELARA, the response rates are higher and the neurological toxicity substantially greater, which is the trade-off a patient and centre weigh.
The reason second-line CAR-T is offered with axicabtagene ciloleucel or lisocabtagene maraleucel rather than tisagenlecleucel. The trial is also the strongest evidence in the field that the interval between apheresis and infusion, and what is given during it, is part of the treatment rather than logistics around it.
Chemotherapy-free cellular therapy for follicular lymphoma that has stopped responding, with a toxicity profile mild enough that the treatment is deliverable outside the largest centres.
Query for this technology: (TITLE:"CAR T" OR ABSTRACT:"CAR T" OR TITLE:"CAR-T" OR ABSTRACT:"CAR-T" OR TITLE:"chimeric antigen receptor T" OR ABSTRACT:"chimeric antigen receptor T"). Results are unfiltered search hits about CAR-T cell therapy, not a curated reading list.
Shares Michael von Bergwelt, A Study of Ciltacabtagene Autoleucel and Talquetamab for the Treatment of Participants With High-Risk Multiple Myeloma, Interleukin-6 and IL-6 receptor, Head-to-head bispecific vs CAR-T in second-line LBCL.
Shares John F. DiPersio, Early relapse: CAR-T before transplant, One CAR-T infusion instead of autologous transplant, Apheresis and starting-material collection.
Shares An open interoperability standard for closed automated cell-processing machines, Digital batch records and AI process control to halve cell therapy batch failures, Public cell-therapy foundries at cancer centres for academics and start-ups, Michal Besser.
Shares A neutral slot exchange so unused CAR-T manufacturing slots go to the next patient, An open interoperability standard for closed automated cell-processing machines, Public reference standards and potency assays for CAR-T so every lab measures alike, Two-day CAR-T manufacture paired with rapid release tests that regulators accept.
Shares Vor Biopharma, CD7, John F. DiPersio, Bellicum Pharmaceuticals.
Shares Non-profit, open-licence lentiviral vectors and producer cell lines for CAR-T, Public-sector CAR-T manufacturing in India, Brazil and South Africa under $50,000, Cipla, Immuneel Therapeutics.