Treatment-Emergent Parkinsonism in Four Patients Treated with Chimeric Antigen Receptor T-Cell Therapy

Treatment-emergent motor and neurocognitive adverse events (MNTs) are rare but increasingly well-documented complications of chimeric antigen receptor T-cell (CAR-T) therapy. Here, we describe the development of parkinsonism in four patients who received CAR-T therapy with either B-cell maturation antigen (BCMA)-targeting ciltacabtagene autoleucel for multiple myeloma (n = 3) or CD-19-targeting axicabtagene autoleucel for lymphoma (n = 1).

We report four cases of parkinsonism in patients who received CAR-T therapy. Two patients had evidence of underlying neurodegenerative parkinsonism, either clinically or through subsequent workup for their movement disorder. All patients received some combination of symptom-directed and immunomodulatory therapies.

This report describes features of CAR-T treatment-emergent parkinsonism, introduces parkinsonism as a potential effect of CD-19-targeted CAR-T therapy, and suggests utility of screening for underlying clinical or biomarker signs of pre-existing neurodegenerative parkinsonism prior to CAR-T infusion.