New clinical trial data reveal a striking trade-off in CAR T cell therapy for smoldering myeloma: while deep remission rates reach approximately 75%, grade 3 or higher adverse events occur in 48% of patients. Cytokine release syndrome affects 62% of treated individuals, and immune effector cell neurotoxicity occurs in 38%. These figures, published in Nature Medicine, underscore that efficacy alone cannot drive clinical decision-making in precancerous disease. The high toxicity burden in asymptomatic patients differs markedly from CAR T use in symptomatic, life-threatening cancers, where severe adverse events may be more readily justified. This data emphasizes that precision patient selection—identifying those most likely to benefit and tolerate treatment—has become the cornerstone of successful CAR T deployment in smoldering myeloma.
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