Patterns of neurotoxicity among patients receiving chimeric antigen receptor T-cell therapy: A single-centre cohort study

Sales, C; Anderson, MA; Kuznetsova, V; Rosenfeld, H; Malpas, CB; Roos, I; Dickinson, M; Harrison, S; Kalincik, T

Author(s): Sales, C; Anderson, MA; Kuznetsova, V; Rosenfeld, H; Malpas, CB; Roos, I; Dickinson, M; Harrison, S; Kalincik, T;
Details: Publication Year 2024-12-12,Volume 31,Issue #3,Page e16174
Journal Title: European Journal of Neurology
Abstract: BACKGROUND AND PURPOSE: Immune effector cell-associated neurotoxicity syndrome (ICANS) is an important complication of chimeric antigen receptor T-cell (CAR-T) therapy. This study aims to identify the patterns of neurotoxicity among patients with ICANS at a tertiary referral centre in Australia. METHODOLOGY: This single-centre, prospective cohort study included all consecutively recruited patients who underwent CAR-T therapy for eligible haematological malignancies. All patients underwent a comprehensive neurological assessment and cognitive screening before CAR-T infusion, during the development of ICANS, and 1 month after treatment. Baseline demographic characteristics, incidence, and neurological patterns of neurotoxicity management were evaluated. RESULTS: Over a 19-month period, 23% (12) of the 53 eligible patients developed neurotoxicity (10/12 [83%] being grade 1). All patients showed changes in handwriting and tremor as their initial presentation. Changes in cognition were manifested in most of the patients, with a more substantial drop noted in their Montreal Cognitive Assessment compared to immune effector cell-associated encephalopathy scores. All manifestations of neurotoxicity were short-lived and resolved within a 1-month period, with a mean duration of 8.2 days (range = 1-33). CONCLUSIONS: The patterns of CAR-T-related neurotoxicity often include change in handwriting, tremor, and mild confusional state, especially early in their evolution. These may remain undetected by routine neurological surveillance. These features represent accessible clinical markers of incipient ICANS.
Publisher: Wiley
Keywords: CAR-T therapy; Icans; axicabtagene ciloleucel; neurotoxicity; tisagenlecleucel
Research Division(s): Blood Cells And Blood Cancer
PubMed ID: 38085272
Publisher's Version: https://doi.org/10.1111/ene.16174
Open Access at Publisher's Site: https://doi.org/10.1111/ene.16174
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-12-21 07:38:44

Last Modified: 2024-03-05 09:29:07