[Neurotoxicities Associated with CAR-T Cell Therapy]

Area of Science:

• Oncology
• Immunotherapy
• Neurology

Background:

• Chimeric antigen receptor (CAR) T cell therapy is now approved in Japan for CD-19-positive B-cell malignancies.
• CAR-T therapy is associated with potential severe side effects, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).

Purpose of the Study:

• To highlight the neurological complications associated with CAR-T cell therapy.
• To emphasize the importance of neurologist awareness and intervention for CRES/ICANS.
• To inform about potential central nervous system disorders linked to pre-CAR-T chemotherapy regimens.

Main Methods:

• Review of recent approvals and known side effects of CAR-T cell therapy.
• Discussion of the clinical manifestations of CRES/ICANS.
• Consideration of neurotoxicity from prior chemotherapeutic agents.

Main Results:

• CAR-T therapy can lead to serious neurological adverse events such as encephalopathy, seizures, and cerebral edema.
• The exact mechanisms of CRES/ICANS are not fully understood.
• Pre-CAR-T chemotherapy may also contribute to central nervous system disorders.

Conclusions:

• Neurologists must be prepared to diagnose and manage CAR-T-related neurological complications.
• Familiarity with both CAR-T-induced neurotoxicity and chemotherapy-induced neurological disorders is crucial for patient care.