Imaging the Side Effects of CAR T Cell Therapy: A Primer for the Practicing Radiologist

Area of Science:

• Immunotherapy
• Oncology
• Radiology

Background:

• Chimeric antigen receptor (CAR) T cell therapy is a potent immunotherapy for hematologic cancers.
• CAR T-cells are engineered lymphocytes targeting tumor antigens to enhance immune response.
• Expanding CAR T-cell therapy use necessitates understanding its side effect presentations.

Purpose of the Study:

• To comprehensively review the radiographic manifestations of common CAR T-cell therapy side effects.
• To guide radiologists in the optimal imaging of these adverse events.
• To facilitate prompt identification and management of treatment complications.

Main Methods:

• Review of existing literature on CAR T-cell therapy and associated side effects.
• Analysis of radiographic findings in various organ systems affected by cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity (ICANS).
• Discussion of best practices for imaging these complications.

Main Results:

• Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity (ICANS) present with distinct radiographic features across different organs.
• Specific imaging patterns are associated with CRS and ICANS, aiding in their identification.
• Understanding these patterns is crucial for accurate diagnosis.

Conclusions:

• Radiographic recognition of CAR T-cell therapy side effects is critical for patient management.
• Optimal imaging strategies can aid in the early detection and treatment of CRS and ICANS.
• This review provides essential knowledge for radiologists managing patients undergoing CAR T-cell therapy.