Immune Effector Cell-Associated Neurotoxicity Syndrome: A Practical Overview for the General Neurologist

Area of Science:

• Oncology
• Neurology
• Immunology

Background:

• Immune effector cell-associated neurotoxicity syndrome (ICANS) is a rare but serious complication of chimeric antigen receptor (CAR) T-cell therapy.
• It affects patients with hematologic malignancies like leukemia, lymphoma, and multiple myeloma.
• Symptoms are often nonspecific neurologic issues, including encephalopathy, language difficulties, and tremors.

Purpose of the Study:

• To consolidate clinical, radiographic, and laboratory findings for immune effector cell-associated neurotoxicity syndrome (ICANS).
• To provide a comprehensive overview of diagnosis and management for physicians.
• To aid in early recognition and intervention for ICANS.

Main Methods:

• Review of clinical, radiographic, and laboratory findings in patients with ICANS.
• Analysis of diagnostic workup including brain imaging, EEG, and lumbar puncture.
• Evaluation of laboratory markers such as C-reactive protein and ferritin for risk stratification.

Main Results:

• Diagnostic workup (imaging, EEG, lumbar puncture) is often normal or nonspecific.
• Laboratory studies like C-reactive protein and ferritin can indicate risk and severity.
• Steroids play a key role in managing neurotoxicity secondary to CAR T-cell therapy.

Conclusions:

• Early recognition of ICANS signs and symptoms allows for timely intervention.
• While most patients recover, rapid progression to death is possible in a minority of cases.
• Management involves supportive care, with steroids being integral for neurotoxicity treatment.