Chimeric antigen receptor T-cell (CAR-T) therapy, originally developed for B-cell malignancies, is rapidly being repurposed for severe systemic autoimmune rheumatic diseases. The rationale extends beyond suppression of autoantibody production, as B cells also function as antigen-presenting cells, cytokine producers, and organizers of pathogenic immune interactions. CD19-directed CAR-T cells can achieve broader and deeper B-cell depletion than conventional antibody-based approaches and may disrupt self-sustaining autoimmune networks. Early clinical experience across systemic autoimmune diseases has shown striking responses, including drug-free remission in selected patients. Importantly, disease control may persist despite CAR-T contraction and subsequent B-cell reconstitution, supporting the concept of an “immune reset,” although this should not be equated with cure. In autoimmune diseases, long-term CAR persistence may not be required, and toxicity profiles and therapeutic goals differ from those in hematologic malignancies. Meanwhile, clinical development is expanding beyond autologous CD19-directed CAR-T cells to BCMA-directed, dual-target, allogeneic, natural killer cell, induced pluripotent stem cell-derived, and in vivo CAR platforms. This review discusses the biological rationale, emerging clinical evidence, safety and management considerations, and future development of CAR-based cellular therapy for systemic autoimmune rheumatic diseases.
Acute- and lymphoma-type adult T-cell leukemia/lymphoma (ATL) is clinically aggressive, but the prognostic significance of the diagnosis-to-treatment interval (DTI) is unclear. We retrospectively analyzed 73 patients with newly diagnosed acute- or lymphoma-type ATL who received systemic chemotherapy between 2003 and 2025. DTI was defined as the interval from diagnosis to chemotherapy initiation, with the diagnosis date defined as the biopsy date rather than the date of pathological confirmation, or, in patients without a biopsy, the date of confirmation by peripheral blood testing. A short DTI was defined as ≤7 days. The median DTI was 11 days. Peripheral blood involvement and acute-type ATL were more frequent in the short DTI group. A short DTI was associated with inferior overall survival (OS) (HR, 1.75; 95
Extramedullary disease (EMD) in acute myeloid leukemia (AML) is a heterogeneous entity, and distinctions between systemic EMD and central nervous system (CNS) leukemia remain poorly understood. We conducted a single-center retrospective study of clinical characteristics, mutational profiles, treatment responses, and survival outcomes in 52 adults with EMD (31 with systemic EMD and 21 with CNS leukemia) treated at the University of Iowa Health Care between 2006 and 2025. Frequencies of NPM1, FLT3, and RAS pathway gene mutations were similar between systemic EMD and CNS leukemia cohorts. Complete remission (CR) rates after induction were comparable between patients with systemic EMD (66.7
