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immune effector cell-associated neurotoxicity syndrome (ICANS)

Etiology: - chimeric antigen receptor T-cell therapy for lymphoma - anti-CD19 Pathology: neurotoxicity Clinical manifestations: - neurological symptoms may include - apraxia, expressive aphasia, disorientation, hallucinations [3] - dysgraphia, confusion, somnolence [4] Laboratory: - CSF analysis [3] Special laboratory: - electroencephalogram (EEG): diffuse slowing (all); focal slowing in 30% [4] Radiology: - brain MRI may be normal [3]; abnormal in 28% [4] Management: - treatment with dexamethasone [3] - median total dose equivalent to 221 mg of dexamethasone for a median duration of 12.5 days (18 mg/day) [4]

General

neurotoxicity autoimmune disease

References

  1. Siegler EL, Kenderian SS Neurotoxicity and Cytokine Release Syndrome After Chimeric Antigen Receptor T Cell Therapy: Insights Into Mechanisms and Novel Therapies. Front Immunol. 2020. Aug 28;11:1973 PMID: 32983132 PMCID: PMC7485001 Free PMC article https://www.frontiersin.org/articles/10.3389/fimmu.2020.01973/full
  2. Holtzman NG, Xie H, Bentzen S et al Immune effector cell-associated neurotoxicity syndrome after chimeric antigen receptor T-cell therapy for lymphoma: predictive biomarkers and clinical outcomes. Neuro Oncol. 2021 Jan 30;23(1):112-121 PMID: 32750704 PMCID: PMC7850044 Free PMC article
  3. Mohn N, Bonda V, Grote-Levi L et al Neurological management and work-up of neurotoxicity associated with CAR T cell therapy. Neurol Res Pract. 2022 Jan 10;4(1):1. PMID: 35000613 PMCID: PMC8744256 Free PMC article
  4. Holzman NG et al Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) after CD19-Directed Chimeric Antigen Receptor T-Cell Therapy (CAR-T) for Large B-Cell Lymphoma: Predictive Biomarkers and Clinical Outcomes. Blood. 2019. 134(Suppl 1)3239 https://ashpublications.org/blood/article/134/Supplement_1/3239/423803/Immune-Effector-Cell-Associated-Neurotoxicity