Table 2.

Next-generation CAR-T cell manufacturing strategies

ProsCons
Accelerated cell manufacturing •Reduced vein-to-vein time
•Less resource intensive
•Increased manufacturing capacity
•Less differentiated T cells in final product
•Potential for reduced T-cell doses 
•Increased potential for contaminating tumor cells in product (particularly for hematological malignancies)
•Potential for T cells having overly active phenotype, leading to increased toxicities
•Complexity in product-release testing (e.g., inability to distinguish between transient protein expression from pseudo-transduction versus stable integration) 
Process automation •Reduced personnel and infrastructure costs
•Reduced probability of human error
•Potential for on-site manufacturing enabling fresh cell products 
•Reduced capability to respond to patient-specific cell behaviors during manufacturing
•Challenge in ensuring consistency across multiple sites for point-of-care manufacturing
•Limited capacity to perform long-term release testing for fresh products 
In vivo cell manufacturing •Cost and time saving from eliminating need for ex vivo cell manufacturing
•Potential for less differentiated T cells
•Off-the shelf reagents instead of patient-specific products 
•Potential genotoxicity and immunogenicity
•Potential transgene insertion into non-T cells
•Unknown safety profile
•Unknown durability 
ProsCons
Accelerated cell manufacturing •Reduced vein-to-vein time
•Less resource intensive
•Increased manufacturing capacity
•Less differentiated T cells in final product
•Potential for reduced T-cell doses 
•Increased potential for contaminating tumor cells in product (particularly for hematological malignancies)
•Potential for T cells having overly active phenotype, leading to increased toxicities
•Complexity in product-release testing (e.g., inability to distinguish between transient protein expression from pseudo-transduction versus stable integration) 
Process automation •Reduced personnel and infrastructure costs
•Reduced probability of human error
•Potential for on-site manufacturing enabling fresh cell products 
•Reduced capability to respond to patient-specific cell behaviors during manufacturing
•Challenge in ensuring consistency across multiple sites for point-of-care manufacturing
•Limited capacity to perform long-term release testing for fresh products 
In vivo cell manufacturing •Cost and time saving from eliminating need for ex vivo cell manufacturing
•Potential for less differentiated T cells
•Off-the shelf reagents instead of patient-specific products 
•Potential genotoxicity and immunogenicity
•Potential transgene insertion into non-T cells
•Unknown safety profile
•Unknown durability 

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