Patterns of neurotoxicity among patients receiving chimeric antigen receptor T‐cell therapy: A single‐centre cohort study

Author:

Sales Carmela12ORCID,Anderson Mary Ann23,Kuznetsova Valeriya124ORCID,Rosenfeld Hannah12,Malpas Charles B.145ORCID,Roos Izanne14ORCID,Dickinson Michael26,Harrison Simon26,Kalincik Tomas14ORCID

Affiliation:

1. Neuroimmunology Centre, Department of Neurology Royal Melbourne Hospital Melbourne Victoria Australia

2. Department of Clinical Haematology Peter MacCallum Cancer Centre, Royal Melbourne Hospital Melbourne Victoria Australia

3. Division of Blood Cells and Blood Cancer Walter and Eliza Hall Institute Parkville Victoria Australia

4. Clinical Outcomes Research (CORe), Department of Medicine University of Melbourne Parkville Victoria Australia

5. Melbourne School of Psychological Sciences University of Melbourne Parkville Victoria Australia

6. Sir Peter MacCallum Department of Oncology University of Melbourne Parkville Victoria Australia

Abstract

AbstractBackground and purposeImmune effector cell‐associated neurotoxicity syndrome (ICANS) is an important complication of chimeric antigen receptor T‐cell (CAR‐T) therapy. This study aims to identify the patterns of neurotoxicity among patients with ICANS at a tertiary referral centre in Australia.MethodologyThis single‐centre, prospective cohort study included all consecutively recruited patients who underwent CAR‐T therapy for eligible haematological malignancies. All patients underwent a comprehensive neurological assessment and cognitive screening before CAR‐T infusion, during the development of ICANS, and 1 month after treatment. Baseline demographic characteristics, incidence, and neurological patterns of neurotoxicity management were evaluated.ResultsOver a 19‐month period, 23% (12) of the 53 eligible patients developed neurotoxicity (10/12 [83%] being grade 1). All patients showed changes in handwriting and tremor as their initial presentation. Changes in cognition were manifested in most of the patients, with a more substantial drop noted in their Montreal Cognitive Assessment compared to immune effector cell‐associated encephalopathy scores. All manifestations of neurotoxicity were short‐lived and resolved within a 1‐month period, with a mean duration of 8.2 days (range = 1–33).ConclusionsThe patterns of CAR‐T‐related neurotoxicity often include change in handwriting, tremor, and mild confusional state, especially early in their evolution. These may remain undetected by routine neurological surveillance. These features represent accessible clinical markers of incipient ICANS.

Publisher

Wiley

Subject

Neurology (clinical),Neurology

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