Long-term Neurologic Safety in Patients With B-Cell Lymphoma Treated With Anti-CD19 Chimeric Antigen Receptor T-Cell
Renata Ursu1, Didier Maillet2, Catherine Belin2
1From the Assistance Publique-Hôpitaux de Paris (AP-HP) (R.U., D.M., C.B., S.C., V.V., L.S.-V., C.C., A.F.C.), Hôpital Saint-Louis, Service de Neurologie; Université de Lille (C.M.), ULR 4072-PSITEC-Psychologie: Interactions, Temps, Emotions, Cognition; Université de Paris (S.C., C.C., R.D.B., C.T., A.F.C.); and Service d' Hémato-Oncologie (R.D.B., C.T.), Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), France. renata.ursu@aphp.fr.
Objectives:
Anti-CD19 chimeric antigen receptor (CAR) T-cell therapy is a promising treatment in relapsing B-cell lymphoma but is frequently associated with acute neurotoxicity. Neurologic long-term safety has not been thoroughly assessed.
Methods:
All patients with consecutive refractory lymphoma admitted in our center for CAR T-cell therapy underwent neurologic examination, extensive neuropsychological assessment, and brain MRI (except 1 patient) and completed self-administrated questionnaires at baseline. The patients who remained disease-free at 2 years were re-evaluated similarly. All neurologic assessments were conducted by senior neurologists.
Results:
None of the 19 disease-free patients developed new neurologic deficits or MRI changes when compared with baseline. There was no difference in cognitive performances before and 2 years after, even for the 11 patients who had developed acute neurotoxicity after CAR T cells. In self-questionnaire assessments, cognitive complaint was stable, reported by 32% of the patients at 2 years. We observed a reduction in HADS anxiety scores 2 years after treatment when compared with baseline (median score: 7/21 vs 4/21, p = 0.01).
Discussion:
In conclusion, no significant neurocognitive or neurologic disorders were observed in this cohort of patients, 2 years after treatment with anti-CD19 CAR T cells.
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