CAR T cells for autoimmune diseases: 2026 update of the EBMT-ISCT-JACIE practice harmonisation and consensus recommendations.

Autoimmune diseases are a heterogeneous group of chronic diseases characterised by loss of immune tolerance with substantial morbidity and mortality. Since 2021, chimeric antigen receptor (CAR) T cells have recently emerged as a promising treatment option for patients with severe, refractory autoimmune diseases. In 2024, an international expert panel from the European Society for Blood and Marrow Transplantation (EBMT), the International Society for Cell and Gene Therapy (ISCT), and the Joint Accreditation Committee of ISCT and EBMT (JACIE) released the first best-practice recommendations on CAR T cells for autoimmune diseases. Using the same consensus methodology, these living recommendations were updated thereafter. The 2026 consensus reviews current evidence and expert practices on CAR T cells for rheumatic, neurological, haematological, other autoimmune diseases, and paediatric indications, providing updated, expert-based recommendations on patient selection, diagnostic investigation, clinical management, follow up, and immune monitoring for each disease group. Unmet needs and future research priorities are also highlighted.