Neuropsychological Functioning in Pediatric Patients With Leukemia or Lymphoma Treated With CAR T-Cell Therapy: A...

Chimeric antigen receptor (CAR) T-cell therapy has emerged as a treatment option for pediatric and young adult patients with relapsed or refractory acute lymphoblastic leukemia and non-Hodgkin's lymphoma. However, limited information is available regarding the neuropsychological sequelae associated with this treatment.

This study utilized a multisite, retrospective chart review methodology to describe neuropsychological functioning of pediatric patients prior to and following CAR T-cell infusion.

In the pre-infusion cohort (n = 26), 39% demonstrated weaknesses (characterized as > 1 SD below the normative mean) on at least one neuropsychological measure, most typically set-shifting, visual motor integration, sustained attention, phonemic fluency, graphomotor processing speed, auditory working memory, and nondominant fine motor functions. In the post-infusion cohort (n = 23), 33% demonstrated impairments (characterized as ≥ 1.5 SD below the normative mean) in full-scale intelligence quotient, graphomotor processing speed, visual-motor integration, and fine motor speeded dexterity. Weaknesses (> 1 SD below the normative mean) in sustained attention, narrative verbal memory, academic skills, verbal fluency, and visual memory were also evident in this cohort. In the pre-post-infusion cohort (n = 6), 83% demonstrated at least one neuropsychological score that declined across time; however, there was variability in the neuropsychological domains that changed. As a group, academic skills declined over time.

While conclusions should be tempered given the heterogeneity of the patient population, these findings offer preliminary evidence for specific neuropsychological outcomes in pediatric patients treated with CAR T-cell therapy. Limitations and implications for future practice are discussed.