Neurological updates: neurological complications of CAR-T therapy

Area of Science:

• Oncology
• Immunology
• Neurology

Background:

• Chimeric antigen receptor (CAR)-T cell therapy is a breakthrough treatment for refractory B cell malignancies.
• Neurological toxicity, termed immune effector cell-associated neurotoxicity syndrome (ICANS), is a frequent complication of CAR-T therapy.

Purpose of the Study:

• To summarize the clinical manifestations, mechanisms, investigations, and treatment of CAR-T-related neurotoxicity.
• To provide guidance for neurologists managing patients receiving licensed CD19 CAR-T products.

Main Methods:

• Review of clinical data and literature on CAR-T-related neurotoxicity.
• Focus on licensed CD19 CAR-T products and associated ICANS.

Main Results:

• ICANS affects over 50% of patients in some cohorts and is usually self-limiting.
• ICANS can be severe, requiring intensive care, but is rarely fatal.

Conclusions:

• CAR-T therapies are increasingly used, necessitating neurologist awareness of potential neurotoxicity.
• Understanding ICANS is crucial for effective patient management and treatment of CAR-T-related neurological complications.