In 2024 a panel from the European Society for Blood and Marrow Transplantation, the International Society for Cell and Gene Therapy and their joint accreditation committee published the first best-practice recommendations on CAR T cells for autoimmune disease. This is the 2026 update of those living recommendations, published in October.
It covers rheumatic, neurological, haematological and other autoimmune diseases, and paediatric indications, with expert recommendations on patient selection, diagnostic work-up, clinical management, follow-up and immune monitoring for each disease group. It also sets out unmet needs and research priorities.
CAR T therapy for autoimmune disease remains largely within trials and specialist centres. For rheumatologists, the value of this document is in knowing which patients with severe, refractory disease might be referred, and what work-up a cellular therapy team will expect.
- CAR T therapy for autoimmune disease is still largely confined to trials and specialist centres.
- Consider referral discussion only for severe disease refractory to standard therapies.
- Expect the cellular therapy team to require structured pre-treatment investigation and long-term monitoring.
- Recommendations are expert consensus, not randomised trial evidence.
Why it matters
Rheumatologists are increasingly asked whether a patient is a CAR T candidate, and this sets out the shared criteria.
Don't overread it
Expert consensus; the efficacy evidence is still early and largely uncontrolled.
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