Consultant, Haemato-Oncology & BMT, Fortis Hospital, Shalimar Bagh, New Delhi
Part 5 of 8 in CAR-T Cell Therapy
Managing Complications After CAR-T Cell Infusion
September 6, 2026
A successful CAR-T infusion is not the end of the story. Dr. Akash Khandelwal was direct with the doctors on the call about what follows infusion, and why close monitoring matters so much in the weeks after.
A unique set of side effects
After CAR-T infusion, patients can develop fever, infections, low platelets and a low white cell count from the chemotherapy that precedes infusion. CAR-T itself carries its own unique subset of complications: cytokine release syndrome, ICANS (a neurological syndrome that can affect the brain), HLH, and low B-cells or hypogammaglobulinaemia, which can lead to infections later on. This distinct pattern of complications is why patients need dedicated, specialist follow-up rather than routine post-chemotherapy care.
Three months of close monitoring
Patients are monitored closely for three months after infusion to catch and manage any of these complications early. In practice, that means an admission of roughly 15 to 20 days immediately after infusion, specifically to counter the most problematic early complications: cytokine release syndrome, fever, low platelet and white cell counts, and ICANS.
Manageable, and rarely severe
The lymphodepleting chemotherapy of cyclophosphamide and fludarabine can cause cytopenias and neutropenia, but the dosing is not high, so this is manageable even in patients who are not especially fit. How severe the CAR-T related side effects become varies from patient to patient and depends partly on how well controlled the underlying disease already is. Even so, Dr. Khandelwal notes that whatever side effects do occur are generally manageable and not life-threatening: he has not seen a death attributable to CAR-T side effects, and such deaths are not well documented in the wider data either.
This article is based on a Jivo Masterclass session conducted by Dr. Akash Khandelwal, Consultant, Haemato-Oncology & BMT, Fortis Hospital, Shalimar Bagh, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Akash Khandelwal taught doctors across Africa on March 9, 2025.
FROM THE LIVE Q&A
Dr. Rabiu Salisu Abdullahi (Nigeria)
Can you elaborate further on the vein-to-vein time you mentioned, around 19 days: how exactly are the cells collected and processed before the transplant?
Dr. Akash Khandelwal
T-cells are collected the same way a stem cell or single-donor platelets are collected, through an apheresis machine. No drugs are given before collection; a vein is all that's needed, and if an adequate number of T-cells is found, CAR-T manufacturing can go ahead.
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Frequently Asked Questions
Is there any risk to hair regrowth after the chemotherapy and CAR-T treatment?▼
The conditioning chemotherapy is just cyclophosphamide and fludarabine, which can cause cytopenias and neutropenia, but this is manageable since the dosing isn't very high, so fitness is not usually a major factor. It's the CAR-T related side effects that vary more from patient to patient. If the disease is well controlled going in, complications are less likely, but even with good control, side effects such as cytokine release syndrome or, less commonly, ICANS (which can affect the brain) can occur. Whatever side effects arise are manageable and not life-threatening: no deaths from CAR-T related side effects have been seen, and it isn't well documented even in the long-term data.
What are the specific cancer cells targeted by CAR-T, and can it be applied to ovarian or cervical cancers?▼
Not yet - it hasn't shown good promise there so far. Currently CAR-T is only available for B-cells, targeting CD19, and this has shown long-term responses based on research done in the US, with a large subset of patients still in remission after CD19-targeted CAR-T infusion. Other categories are in development too, such as dual-target CARs and attachments that help CAR-T expand and persist for longer, but currently only CD19 CAR-T can be offered, since that's what's commercially available in India.
Where do you see CAR-T cell therapy heading in other cancers?▼
CAR-T cells are likely to become a first-line option in almost all cancers within the next 5 to 10 years. If it doesn't get there, that would actually be a missed opportunity, because it targets cells in a very different and unique way. More and more data is showing increasing promise for the treatment.
If possible, could you share your slides with us so we can go through the presentation again?▼
Yes, no problem: the slides will be shared after the session.
How many CAR-T cells are required per kilogram of body weight?▼
The cutoff is 5 million CAR-T cells required per kilogram of the patient's body weight.
What complications can follow CAR-T cell infusion?▼
Fever, infections, low platelets and low white cell counts from the pre-infusion chemotherapy, plus CAR-T specific complications: cytokine release syndrome, ICANS, HLH, and hypogammaglobulinaemia leading to later infections.
How long are patients monitored after CAR-T infusion?▼
Closely for three months, with a hospital admission of roughly 15 to 20 days immediately after infusion to manage the most problematic early complications.
Is CAR-T cell therapy dangerous?▼
Side effects vary from patient to patient but are generally manageable and not life-threatening. No deaths attributable to CAR-T side effects have been seen in this practice, and such deaths are not well documented more broadly either.
In This Series: CAR-T Cell Therapy
- 1.CAR-T Cell Therapy
- 2.What Is CAR-T Cell Therapy and How Does It Work?
- 3.The CAR-T Cell Therapy Timeline: From Collection to Infusion
- 4.Who Is Eligible for CAR-T Cell Therapy?
- 5.Managing Complications After CAR-T Cell Infusion
- 6.CAR-T Cell Therapy Outcomes: What the Data Shows
- 7.The Cost and Availability of CAR-T Cell Therapy in India
- 8.The Future of CAR-T Cell Therapy: Beyond Lymphoma and Leukaemia