Table 8 Characteristics and management of CAR-T associated ICANS
From: Deep insight into cytokine storm: from pathogenesis to treatment
Characteristics Recognition and management | |
|---|---|
Signs and symptoms483 | Initiation: drowsiness, disorientation, inattention, tremors, expressive aphasia, dysgraphia, and apraxia |
Progress: cognitive impairment, focal motor and sensory deficits, epilepsy, fatal cerebral edema, and intracranial hemorrhage | |
Long-term sequelae | |
Development time482 | Usually occurs concurrently with or shortly after CRS |
Delayed instances starting >3 weeks after CAR T cell infusion | |
Cytokine profile251 | Plasma: IFN-γ, IL-15, IL-6, IL-10, GM-CSF, IL-1RA, IL-2, IP-10, IL-1β, IL-8, TNF Cerebrospinal fluid: the cytokine profile was similar to that of serum, except for elevated levels of IL-8, CXCL-10 and MCP-1 |
Risk factor482 | Patient characteristics: CRS, disease type, high disease burden, past thrombocytopenia and endothelial activation, and past neurological comorbidities |
CAR-T cell product features: targeted CD19, CD28 co-stimulatory domains, receiving fodarabine and cyclophosphamide, high-dose infusion, high levels of serum CAR-T cells | |
Diagnostic evaluation482 | ICE score and/or CAPD score |
Neurology consultation; Brain PET–CT, brain MRI, and EEG | |
Rule out infection and leptomeningeal malignancy | |
ICANS scoring | |
Management measure482 | Supportive treatment |
Glucocorticoids, tocilizumab (only when accompanied by CRS), antiepileptic drugs | |
Intrathecal hydrocortisone ± intrathecal chemotherapy, anakinra, siltuximab, ruxolitinib, cyclophosphamide and/or antithymocyte globulin | |
ICU treatment, airway protection, special nerve intensive therapy | |
