[The risk and management strategies for second primary tumor after CAR-T cell therapy].
- 1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China Tianjin Institutes of Health Science, Tianjin 301600, China.
Abstract
Chimeric antigen receptor T (CAR-T) cell therapy has revolutionized the treatment of refractory hematologic malignancies, but its long-term safety has become an increasing concern. Secondary primary malignancies (SPM) following CAR-T-cell therapy have emerged as a growing focus of clinical and translational research. Evidence to date suggests that the incidence of different types of SPMs vary, with a two-year cumulative incidence ranging from approximately 0.08% to 8% and a median time to onset of 9.7 to 26.4 months, predominantly involving myeloid malignancies such as myelodysplastic syndromes and acute myeloid leukemia, while solid tumors and rare T-cell lymphomas have also been reported. CAR transgenes have been detected in only a minority of T-cell lymphoma cases. The mechanisms involved vector-related genomic integration risks, genotoxic stress from prior chemotherapy or hematopoietic stem cell transplantation, immune dysregulation, and clonal hematopoietic expansion. Future research may focus on developing safer gene-editing technologies, moving CAR-T-cell therapy to earlier treatment lines to reduce cumulative toxicity from prior therapies, implementing genetic risk screening before treatment, and establishing long-term systematic monitoring after therapy. By optimizing full-process management, the risk of SPM can be minimized, thereby improving the long-term safety of CAR-T-cell therapy while maintaining its therapeutic efficacy.
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BibTeX
@article{li2026risk,
title = {{[The risk and management strategies for second primary tumor after CAR-T cell therapy].}},
author = {R N Li and W Y Wang and F Yang and L L Zhang and J Shi},
journal = {Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi},
year = {2026},
month = aug,
doi = {10.3760/cma.j.cn121090-20260118-00036},
url = {https://europepmc.org/article/MED/42851188},
note = {CC BY},
}
RIS
TY - JOUR
TI - [The risk and management strategies for second primary tumor after CAR-T cell therapy].
AU - R N Li
AU - W Y Wang
AU - F Yang
AU - L L Zhang
AU - J Shi
PY - 2026
DA - 2026/08/01
JO - Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi
DO - 10.3760/cma.j.cn121090-20260118-00036
UR - https://europepmc.org/article/MED/42851188
AB - Chimeric antigen receptor T (CAR-T) cell therapy has revolutionized the treatment of refractory hematologic malignancies, but its long-term safety has become an increasing concern. Secondary primary malignancies (SPM) following CAR-T-cell therapy have emerged as a growing focus of clinical and translational research. Evidence to date suggests that the incidence of different types of SPMs vary, with a two-year cumulative incidence ranging from approximately 0.08% to 8% and a median time to onset of 9.7 to 26.4 months, predominantly involving myeloid malignancies such as myelodysplastic syndromes and acute myeloid leukemia, while solid tumors and rare T-cell lymphomas have also been reported. CAR transgenes have been detected in only a minority of T-cell lymphoma cases. The mechanisms involved vector-related genomic integration risks, genotoxic stress from prior chemotherapy or hematopoietic stem cell transplantation, immune dysregulation, and clonal hematopoietic expansion. Future research may focus on developing safer gene-editing technologies, moving CAR-T-cell therapy to earlier treatment lines to reduce cumulative toxicity from prior therapies, implementing genetic risk screening before treatment, and establishing long-term systematic monitoring after therapy. By optimizing full-process management, the risk of SPM can be minimized, thereby improving the long-term safety of CAR-T-cell therapy while maintaining its therapeutic efficacy.
SN - 0253-2727
SN - 2707-9740
ER -