Clinical predictors of chimeric antigen receptor T-cell therapy neurotoxicity: a single-center study

Aims: Neurotoxicity (NT) is a common complication of chimeric antigen receptor (CAR) T-cell therapy. Data on early clinical identifiers for impending severe NT are lacking. Methods: The authors performed a retrospective study on 26 adult relapsed/refractory diffuse large B cell lymphoma patients treated with commercial CAR T-cell therapy (December 2017 - September 2018). Results: NT of any grade and severe NT occurred in 88 and 31% of patients, respectively. Dysgraphia (p < 0.01), disorientation (p = 0.01) and inattention (p = 0.018) were associated with severe NT, with positive predictive values of 100, 87.5 and 87.5%, respectively. Dysnomia was not associated with severe NT. Conclusion: In the authors' limited cohort, the dysgraphia, disorientation and inattention components of the CAR T-cell therapy-associated toxicity 10 scoring system were significantly associated with and predictive of impending severe NT. Lay abstract Neurotoxicity (NT) is a common complication of chimeric antigen receptor (CAR) T-cell therapy. Information on early signs and symptoms of impending severe NT is lacking. The authors studied 26 adult patients with relapsed/refractory diffuse large B-cell lymphoma who received commercial CAR T-cell therapy for the development of NT. The authors found that NT was common, with 31% of patients experiencing severe NT. In this relatively small patient population, the authors found that impaired writing, disorientation and poor attention, which are components of the CAR T-cell therapy-associated toxicity 10 scoring system, were significantly associated with and predictive of impending severe NT.

Automated summary

Neurotoxicity is a common complication of CAR T-cell therapy, and indicators such as dysgraphia, disorientation, and inattention can help predict impending severe neurotoxicity.