A systematic review is refining how therapy-related myeloid neoplasms emerge after CAR-T versus autologous stem cell transplantation. Across nine included studies, therapy-related myeloid neoplasms appeared earlier after CAR-T and carried worse survival compared with autologous transplant. The analysis also points to clonal hematopoiesis drivers shared between the two settings, highlighting mutations in DNMT3A, TET2, and TP53 as common pathways. For clinicians and trial designers, the framework helps quantify a safety signal that increasingly intersects long-term survivorship planning after cell therapies. With CAR-T use expanding, the review’s timing and clonal genetics data support the case for tailored monitoring strategies and risk-stratified follow-up studies.