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Neurotoxicity—CAR T-cell therapy: what the neurologist needs to know
  1. Lorna Neill1,2,
  2. Jeremy Rees3,
  3. Claire Roddie2
  1. 1University College London Hospitals NHS Foundation Trust, London, UK
  2. 2University College London, London, UK
  3. 3Neurology, National Hospital for Neurology and Neurosurgery, London, UK
  1. Correspondence to Dr Claire Roddie, University College London, London WC1E 6BT, UK; c.roddie{at}ucl.ac.uk

Abstract

Chimeric antigen receptor (CAR) T-cell therapy is one of the most innovative therapies for haematological malignancies to emerge in a generation. Clinical studies have shown that a single dose of CAR T-cells can deliver durable clinical remissions for some patients with B-cell cancers where conventional therapies have failed.

A significant complication of CAR therapy is the immune effector cell-associated neurotoxicity syndrome (ICANS). This syndrome presents a continuum from mild tremor to cerebral oedema and in a minority of cases, death. Management of ICANS is mainly supportive, with a focus on seizure prevention and attenuation of the immune system, often using corticosteroids. Parallel investigation to exclude other central nervous system pathologies (infection, disease progression) is critical. In this review, we discuss current paradigms around CAR T-cell therapy, with a focus on appropriate investigation and management of ICANS.

  • Tumours
  • Toxicology
  • Neuropathology
  • Neurooncology
  • Epilepsy
  • Paraneoplastic syndrome
  • Clinical neurology
  • Haematology
  • Oncology
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Footnotes

  • Contributors NL, JR and CR authors contributed to the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CR has received speaker fees from Novartis, Kite Gilead and Celgene. LN has been supported by Celgene to attend an academic conference.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned. Externally peer reviewed by David McKee, Manchester, UK.

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