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

Cognitive dysfunction is a common manifestation of immune effector cell-associated neurotoxicity syndrome (ICANS) following chimeric antigen receptor (CAR) T-cell therapy. ICANS may be life-threatening and so necessitates rapid recognition and intervention. This study investigated the utility of a computerized test of attention and processing speed (CARTcog) for monitoring ICANS. In this prospective pilot study, 89 CAR-T patients (71% male, mean age at infusion = 67.18 yr) completed 1149 CARTcog tests and 5347 ICE scores during their inpatient stay. Of the 89 participants, 30 (34%) developed ICANS. Receiver operating characteristic analysis demonstrated that five of six CARTcog scores had moderate discriminatory power in identifying patients who develop ICANS in the following 12 hours (area under the curve = 0.77 to 0.79). Cutoffs were derived, and Bayesian generalized linear mixed models demonstrated that the reaction times above the cutoff on the choice reaction task were associated with an almost 20-fold increase in the odds of developing ICANS (OR = 19.64 [95% credible interval 5.14 to 96.20]). Three case studies illustrate the practical utility of CARTcog. CARTcog may facilitate early detection of ICANS and thereby enhance patient safety and treatment outcomes.