Details

Autor(en) / Beteiligte

• Rubin, Daniel B
• Danish, Husain H
• Ali, Ali Basil
• Li, Karen
• LaRose, Sarah
• Monk, Andrew D
• Cote, David J
• Spendley, Lauren
• Kim, Angela H
• Robertson, Matthew S
• Torre, Matthew
• Smith, Timothy R
• Izzy, Saef
• Jacobson, Caron A
• Lee, Jong Woo
• Vaitkevicius, Henrikas

Titel

Neurological toxicities associated with chimeric antigen receptor T-cell therapy

Ist Teil von

• Brain (London, England : 1878), 2019-05, Vol.142 (5), p.1334-1348

Ort / Verlag

England: Oxford University Press

Erscheinungsjahr

2019

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• Patients treated with chimeric antigen receptor (CAR) T cell therapy often develop severe neurological toxicities associated with focal neurological deficits that are incompletely understood. Rubin et al. catalogue the neurological symptoms in 100 consecutive patients receiving CAR T cell therapy, characterizing the common clinical features and diagnostic findings. Abstract Chimeric antigen receptor T cell therapy has become an important tool in the treatment of relapsed and refractory malignancy; however, it is associated with significant neurological toxicity. We characterized the neurological toxicity associated with chimeric antigen receptor T-cell therapy in a consecutive series of 100 patients up to 2 months post transfusion, 28 of whom were obtained from chart review and the others by prospective observation. The underlying neoplasms were lymphoma (74%), myeloma (14%), leukaemia (10%), and sarcoma (2%). The median age of the cohort was 64.5 years old and 39% of patients were female. The most commonly occurring neurological symptoms were encephalopathy (57%), headache (42%), tremor (38%), aphasia (35%) and focal weakness (11%). Focal neurological deficits are frequently observed after chimeric antigen receptor T-cell therapy and are associated with regional EEG abnormalities, FDG-PET hypometabolism, and elevated velocities on transcranial Doppler ultrasound. In contrast, structural imaging was typically normal. As this form of treatment is more widely adopted, recognition of the frequently encountered symptoms will be of increasing importance for the neurologists and oncologists caring for this growing patient population.