Neuralgic Amyotrophy Following B-Cell Maturation Antigen-Directed CAR-T Therapy

Area of Science:

• Hematology
• Neurology
• Oncology

Background:

• Chimeric antigen receptor T-cell (CAR-T) therapy offers a promising treatment for refractory hematologic malignancies.
• Neurologic complications, including immune effector cell-associated neurotoxicity syndrome, are known adverse events.
• Peripheral neuropathies, such as neuralgic amyotrophy, are rarely reported following CAR-T therapy.

Purpose of the Study:

• To characterize the clinical, electrophysiologic, and imaging features of neuralgic amyotrophy after B-cell maturation antigen (BCMA)-directed CAR-T therapy.
• To raise awareness among clinicians regarding this potential complication.

Main Methods:

• Retrospective case series at a single tertiary care center.
• Clinical evaluation, electrophysiologic studies (electromyography), and imaging.
• Analysis of patient data following BCMA-directed CAR-T therapy.

Main Results:

• Four patients (1.5%) developed neuralgic amyotrophy after BCMA-directed CAR-T therapy.
• Onset of acute bilateral shoulder pain and weakness occurred 8-12 days post-infusion.
• Electromyography revealed denervation predominantly in muscles innervated by the long thoracic and suprascapular nerves. Corticosteroid treatment showed partial efficacy.

Conclusions:

• Neuralgic amyotrophy is an underrecognized complication of BCMA-directed CAR-T therapy.
• The presentation suggests an inflammatory mechanism, supported by timing, bilateral involvement, and response to corticosteroids.
• Vigilance for neuralgic amyotrophy is crucial for prompt diagnosis and management to prevent long-term neurological deficits.