Is EEG useful in predicting neurotoxicity and outcomes related to chimeric antigen receptor (CAR) T-cell therapy?

Chimeric antigen receptor (CAR) T-cell therapy revolutionized cancer treatment, though has potential for neurotoxicity (immune effector cell-associated neurotoxicity syndrome, ICANS). EEG has been proposed as a predictive and prognostic tool in ICANS.

Evaluate pre-treatment EEG, neuroimaging, and clinical features in predicting ICANS, and EEG in prognosis in ICANS.

Retrospective multicenter study involving adult patients who underwent CAR T-cell therapy at Mayo Clinic Florida, Minnesota, and Arizona between October 2019 and July 2024. Univariable, multivariable and survival analyses were performed.

We included 207 patients (111 female). Pre-treatment EEG was performed in 50.2 % of patients. Multivariable analysis of EEG, imaging, and clinical data demonstrated older age (roughly 1 % increased odds per 1 year of increased age, p = 0.006) and generalized slowing on pre-treatment EEG being associated with ICANS (p = 0.021). There were no factors predictive of hospital duration or survival in ICANS using multivariable analysis. Patients with ICANS had longer hospitalization (p < 0.001) and were less likely to survive at 12- and 24-months (p = 0.001, p < 0.001 respectively).

ICANS is associated with longer hospitalization and worse survival. ICANS risk increases with older age. Generalized slowing on pre-treatment EEG may identify patients at risk of ICANS.

ICANS is associated with worse outcomes and may be predicted by pre-treatment EEG and older age.