Intrathecal hydrocortisone for treatment of children and young adults with CAR T‐cell immune‐effector cell‐associated neurotoxicity syndrome

Shalabi, Haneen; Harrison, Cynthia; Yates, Bonnie; Calvo, Katherine R.; Lee, Daniel W.; Shah, Nirali N.

doi:10.1002/pbc.30741

Cited by 5 publications

(1 citation statement)

References 20 publications

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“…If ICANS does not respond to glucocorticoids, siltuximab, ruxolitinib, anakinra, dasatinib, and cyclophosphamide can be administered [7]. In pediatric patients with acute lymphoblastic leukemia who developed ICANS after CAR-T-cell therapy, intrathecal hydrocortisone showed a beneficial effect [18].…”

Section: Discussionmentioning

confidence: 99%

Glofitamab-Associated Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) Presenting as Serial Seizures and Responding Positively to Antiseizure Drugs and Anakinra: A Case Report

Finsterer

2024

Cureus

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Immune effector cell-associated neurotoxicity syndrome (ICANS) is a well-known side effect of chimeric antigen receptor (CAR) T-cell therapy but has occasionally been described with immune checkpoint inhibitors as well. Glofitamab-associated ICANS with a bispecific monoclonal antibody has rarely been reported. The patient is a 63-year-old male with a history of mantle cell lymphoma, diagnosed at age 37, and aggressive large-cell B-cell lymphoma, diagnosed at age 50. Despite adequate chemotherapy, immunotherapy, autologous stem cell transplantation, and CAR T-cell therapy, there were several relapses, including meningeal carcinomatosis at age 61 and intracerebral lymphoma at age 62. For this reason, glofitamab was started. One week after the ninth cycle, the patient developed drowsiness, behavioral changes, word-finding difficulties, aphasia, focal to bilateral tonic-clonic seizures, and focal onset seizures, which resolved after 16 days with levetiracetam, valproic acid, lorazepam, and midazolam. Since there was no infectious disease, electrolyte disturbance, metabolic disorder, cardiovascular disease, or relapse of lymphoma, glofitamab-associated ICANS was suspected, and anakinra was administered. The case shows that ICANS with drowsiness, behavioral changes, aphasia, and seizures can develop with glofitamab and that patients with structural brain abnormalities may be prone to this.

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Section: Discussionmentioning

confidence: 99%

Glofitamab-Associated Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) Presenting as Serial Seizures and Responding Positively to Antiseizure Drugs and Anakinra: A Case Report

Finsterer

2024

Cureus

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Evolving strategies for addressing CAR T-cell toxicities

Rankin,

Duncan,

Allen

et al. 2024

Cancer Metastasis Rev

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The field of chimeric antigen receptor (CAR) T-cell therapy has grown from a fully experimental concept to now boasting a multitude of treatments including six FDA-approved products targeting various hematologic malignancies. Yet, along with their efficacy, these therapies come with side effects requiring timely and thoughtful interventions. In this review, we discuss the most common toxicities associated with CAR T-cells to date, highlighting risk factors, prognostication, implications for critical care management, patient experience optimization, and ongoing work in the field of toxicity mitigation. Understanding the current state of the field and standards of practice is critical in order to improve and manage potential toxicities of both current and novel CAR T-cell therapies as they are applied in the clinic.

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Current understanding and management of CAR T cell-associated toxicities

Brudno,

Kochenderfer

2024

Nat Rev Clin Oncol

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Intrathecal hydrocortisone for treatment of children and young adults with CAR T‐cell immune‐effector cell‐associated neurotoxicity syndrome

Cited by 5 publications

References 20 publications

Glofitamab-Associated Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) Presenting as Serial Seizures and Responding Positively to Antiseizure Drugs and Anakinra: A Case Report

Glofitamab-Associated Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) Presenting as Serial Seizures and Responding Positively to Antiseizure Drugs and Anakinra: A Case Report

Evolving strategies for addressing CAR T-cell toxicities

Current understanding and management of CAR T cell-associated toxicities

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