Novartis confirmed additional tumor reports in children treated with Zolgensma (onasemnogene abeparvovec-xioi), bringing total reported cases to nine, with two showing evidence of vector DNA integration. The company said authorities were notified in each case and emphasized that vector integration risk is already described in the therapy’s prescribing information. The disclosed cases add pressure on the gene therapy field to refine long-term surveillance and to clarify clinical relevance of integration findings. They also raise operational questions for registries, oncologic workups after therapy, and how clinicians weigh AAV benefits versus rare malignancy signals. From a development perspective, the report intensifies scrutiny on AAV design, follow-up protocols, and risk communication strategies for current and next-generation in vivo gene delivery programs.