TNF and cancer: This concern is overcome in patients such as lymphopenia that may not have sufficient lymphocytes to produce genetically engineered donor cells without autoimmune molecules such as class 1 HLA.17,18 As CAR-T cells bind explicitly to tumor-associated antigens, T cells are triggered by phosphorylation that leads to the release of cytokines and cancer cells’ death.19 Engineered T cells promote cell death through two main pathways: first, the release of perforin and granules, and second, through the triggering of the Fas or TNF signals.