CAR-T cell therapies

Chimeric antigen receptor T-cell (CAR-T) therapy has rapidly reshaped the therapeutic landscape for children and adolescents with relapsed or refractory hematologic malignancies. In Brazil, the integration of CAR-T therapy into pediatric oncology practice faces unique logistical, regulatory, and socioeconomic challenges, highlighting the need for structured, context-specific guidance. This national pediatric consensus summarizes current evidence and provides practical recommendations for indications, leukapheresis, washout strategies, bridging therapy, lymphodepletion, infusion procedures, and the management of toxicities, including cytokine release syndrome, immune effector cellassociated neurotoxicity syndrome, coagulopathy, and HLH-like syndromes. Long-term follow-up, immune reconstitution monitoring, vaccination guidance, and survivorship considerations are also addressed. Emerging applications in myeloid malignancies, T-cell neoplasms, and solid tumors—particularly GD2-targeted CAR-T cells for neuroblastoma—are briefly reviewed. By consolidating multidisciplinary expertise from institutions across Brazil, this document sought to support safe, effective, and equitable implementation of CAR-T therapy in the pediatric population and encourages continued development of local manufacturing and academic protocols to expand access to this transformative treatment.