CAR T-cell therapy-associated neurotoxicity
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CAR T-cell therapy-associated neurotoxicity CAR T-cell therapy is associated with a high incidence of neurotoxicity which can be predicted by a score based on clinical and laboratory values, say authors of a US study published in JAMA Neurology. This study conducted at Brigham and Women’s Hospital/Dana Farber Cancer Institute, Boston, Massachusetts, between April 2015 and February 2020 investigated the use of a tool for predicting the development of CAR-associated neurotoxicity in 204 patients with relapsed or refractory lymphoma undergoing treatment with axicabtagene ciloleucel. Patients were followed up for 30 days post-infusion. Patients who were admitted between April 2015 and April 2019 (61.8%) comprised the derivation cohort, and patients who were admitted between May 2019 and February 2020 (38.2%) comprised an internal validation cohort. Neurotoxicity was reported in 57.9% of patients in the derivation cohort and 57.7% of patients in the validation cohort, and was grade 3 or 4 in 33 and 18 patients, respectively. The median time to onset of neurotoxicity was six and seven days, respectively. Clinical and laboratory values during the day of infusion and the next five days in the derivation cohort were used to develop a score to predict the development of neurotoxicity. Histological subtype of lymphoma, age ≥52 years, maximum temperature ≥38.5°C, maximum serum C-reactive protein ≥8.95 ng/mL, maximum serum ferritin ≥641 ng/mL, minimum WBC count ≤790/µL, cytokine release syndrome (CRS) severity, CRS onset day 1 or 2, and the number of doses of tocilizumab were predictive of neurotoxicity in multivariate analysis. When used in the validation cohort, the predictive score had an area under the curve of 74%, 77% accuracy, 82% sensitivity and 70% specificity in predicting neurotoxicity. "The score developed in this study may allow clinicians to more precisely allocate resources, anticipate patient needs, and facilitate earlier discharge from the hospital," said the investigators. Rubin DB, et al. Clinical Predictors of Neurotoxicity After Chimeric Antigen Receptor T-Cell Therapy. JAMA Neurology : 10 Aug 2020. Available from: URL: http:// 803497952 doi.org/10.1001/jamaneurol.2020.2703
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Reactions 22 Aug 2020 No. 1818
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