RESULTS: Majority of the studies focused on therapeutic aspect indicating a paucity of data on RW CAR-T use. Most CAR-Ts approved through abbreviated pathways cause concerns for long-term safety, usually due to neurotoxicity and cytokine release syndrome, which has been addressed through use of registries, surrogate endpoints, external control arms and tokenization. Varied patient responses and relapses have necessitated the need to monitor effectiveness. Whole genome sequencing, next generation sequencing, and liquid biopsies have provided an understanding of genomic instability and other biomarkers relative to patient response. Such techniques complemented with traditional imaging and treatment outcomes can be used to understand RW patient responses to CAR-T. Substantial challenges are posed by person-specific immunology, manufacturing, transportation, cell-banking solutions, and lack of standardization. RWE provides insights on clinical responses in subsets of patient groups and operational logistics enhancing its feasibility. Lack of data on quality of life and patient reported outcomes has inspired investigators to capture these variables. RWE through comparative effectiveness, cost-effectiveness, and drug utilization studies, has provided evidence to influence payers’ perspective bridging the gap between development and use in the RW.