CAR T cell therapy demonstrates compelling efficacy in smoldering myeloma, an asymptomatic precancerous blood disorder, achieving deep remissions in approximately 75% of treated patients according to new Nature Medicine data. However, the promise comes with substantial risks: nearly half of recipients experience grade 3 or higher adverse events, including cytokine release syndrome and immune effector cell neurotoxicity. The findings highlight a critical distinction between deploying CAR T in life-threatening active malignancies versus precancerous conditions. Clinicians and patients must engage in rigorous shared decision-making, weighing the potential to alter disease trajectory against the genuine possibility of severe toxicity. Success increasingly depends not on universal application of the therapy, but on sophisticated patient selection and comprehensive risk stratification before treatment initiation.
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