Neurologic testing in the management of CAR T-cell therapy toxicities
| . | Before CAR T-cell therapy . | From 1 to 30 d after CAR T-cell therapy . | 1 mo after CAR–T-cell therapy . |
|---|---|---|---|
| Neurological assessment | YES, baseline mental status, neuro history (Nervous system toxicity from prior therapy, seizure, stroke, migraine, CNS disease, radiation, trauma, andneuropathy). | YES, monitor ICANS, additional attention to handwriting, movement, and personality changes for BCMA-CAR T-cell therapy. High-prolonged CRS increases the risk of ICANS. | YES, full assessment at 1-3-6 months may be indicated in the case of delayed or prolonged neurotoxicity or in the case of BCMA products to screen for early signs of movement and MNTs. |
| EEG | Generally, not helpful unless a history of epilepsy. | YES, during ICANS to r/o nonconvulsive seizures and to monitor critically ill patients. | YES, consider if any recurrent altered mental status. |
| Neuroimaging | YES, if history of CNS disease in cases of preexisting neurologic injury. | YES, if ICANS occurs. | YES, for any delayed neurologic symptoms. |
| CAR T measurements (blood and CSF) | N/A | Unclear utility in the short-term management. | May be helpful if available. High levels of CAR T cells in blood have been associated with recurrent symptoms/delayed neurotoxicity. The role of CSF CAR measurement is unclear. |
| LP for CSF evaluation | YES, strongly consider if history of CNS disease. | May be diagnostic and therapeutic during ICANS. | May be diagnostic and therapeutic to rule out alternative etiologies in case of new neurologic symptoms. |
| . | Before CAR T-cell therapy . | From 1 to 30 d after CAR T-cell therapy . | 1 mo after CAR–T-cell therapy . |
|---|---|---|---|
| Neurological assessment | YES, baseline mental status, neuro history (Nervous system toxicity from prior therapy, seizure, stroke, migraine, CNS disease, radiation, trauma, andneuropathy). | YES, monitor ICANS, additional attention to handwriting, movement, and personality changes for BCMA-CAR T-cell therapy. High-prolonged CRS increases the risk of ICANS. | YES, full assessment at 1-3-6 months may be indicated in the case of delayed or prolonged neurotoxicity or in the case of BCMA products to screen for early signs of movement and MNTs. |
| EEG | Generally, not helpful unless a history of epilepsy. | YES, during ICANS to r/o nonconvulsive seizures and to monitor critically ill patients. | YES, consider if any recurrent altered mental status. |
| Neuroimaging | YES, if history of CNS disease in cases of preexisting neurologic injury. | YES, if ICANS occurs. | YES, for any delayed neurologic symptoms. |
| CAR T measurements (blood and CSF) | N/A | Unclear utility in the short-term management. | May be helpful if available. High levels of CAR T cells in blood have been associated with recurrent symptoms/delayed neurotoxicity. The role of CSF CAR measurement is unclear. |
| LP for CSF evaluation | YES, strongly consider if history of CNS disease. | May be diagnostic and therapeutic during ICANS. | May be diagnostic and therapeutic to rule out alternative etiologies in case of new neurologic symptoms. |
N/A, not available; r/o, rule out.