A Computerized Cognitive Test for Immune Effector Cell-Associated Neurotoxicity Syndrome in Chimeric Antigen Receptor...

Area of Science:

• Neuroscience
• Oncology
• Immunology

Background:

• Cognitive dysfunction is a frequent complication of chimeric-antigen receptor (CAR) T-cell therapy, manifesting as immune effector cell-associated neurotoxicity syndrome (ICANS).
• ICANS poses a significant risk to patients, necessitating prompt identification and management.
• This study evaluated the effectiveness of a computerized test, CARTcog, for monitoring ICANS.

Purpose of the Study:

• To investigate the utility of the CARTcog test for monitoring ICANS in patients undergoing CAR T-cell therapy.
• To assess CARTcog's ability to detect early signs of ICANS.
• To determine if CARTcog can improve patient safety and treatment outcomes.

Main Methods:

• A prospective pilot study involving 89 CAR T-cell therapy patients.
• Patients completed 1,149 CARTcog tests and 5,347 immune effector cell-associated encephalopathy (ICE) scores during their inpatient stay.
• CARTcog assesses reaction times and accuracy across tasks of increasing cognitive complexity.

Main Results:

• 34% of patients (30 out of 89) developed ICANS.
• CARTcog scores demonstrated moderate discriminatory power in predicting ICANS within 12 hours (AUC = 0.77-0.79).
• Elevated reaction times on CARTcog tasks were associated with a significant increase in the odds of developing ICANS (up to a 20-fold increase).

Conclusions:

• Serial assessments using CARTcog are feasible and useful for ICANS monitoring.
• CARTcog has the potential to facilitate early detection of ICANS.
• Early detection via CARTcog may enhance patient safety and improve treatment outcomes.