TY - JOUR
T1 - Immune Effector Cell Associated Neurotoxicity (ICANS) in Pediatric and Young Adult Patients Following Chimeric Antigen Receptor (CAR) T-Cell Therapy
T2 - Can We Optimize Early Diagnosis?
AU - Brown, Brandon Douglas
AU - Tambaro, Francesco Paolo
AU - Kohorst, Mira
AU - Chi, Linda
AU - Mahadeo, Kris Michael
AU - Tewari, Priti
AU - Petropoulos, Demetrios
AU - Slopis, John M.
AU - Sadighi, Zsila
AU - Khazal, Sajad
N1 - Publisher Copyright:
© Copyright © 2021 Brown, Tambaro, Kohorst, Chi, Mahadeo, Tewari, Petropoulos, Slopis, Sadighi and Khazal.
PY - 2021/3/8
Y1 - 2021/3/8
N2 - The Cornell Assessment for Pediatric Delirium (CAPD) was first proposed by the Pediatric Acute Lung Injury and Sepsis Investigators Network-Stem Cell Transplantation and Cancer Immunotherapy Subgroup and MD Anderson CARTOX joint working committees, for detection of immune effector cell associated neurotoxicity (ICANS) in pediatric patients receiving chimeric antigen receptor (CAR) T-cell therapy. It was subsequently adopted by the American Society for Transplantation and Cellular Therapy. The utility of CAPD as a screening tool for early diagnosis of ICANS has not been fully characterized. We conducted a retrospective study of pediatric and young adult patients (n=15) receiving standard-of-care CAR T-cell products. Cytokine release syndrome (CRS) and ICANS occurred in 87% and 40% of patients, respectively. ICANS was associated with significantly higher peaks of serum ferritin. A change in CAPD from a prior baseline was noted in 60% of patients with ICANS, 24–72 h prior to diagnosis of ICANS. The median change from baseline to maximum CAPD score of patients who developed ICANS versus those who did not was 13 versus 3, respectively (p=0.0004). Changes in CAPD score from baseline may be the earliest indicator of ICANS among pediatric and young adult patients which may warrant closer monitoring, with more frequent CAPD assessments.
AB - The Cornell Assessment for Pediatric Delirium (CAPD) was first proposed by the Pediatric Acute Lung Injury and Sepsis Investigators Network-Stem Cell Transplantation and Cancer Immunotherapy Subgroup and MD Anderson CARTOX joint working committees, for detection of immune effector cell associated neurotoxicity (ICANS) in pediatric patients receiving chimeric antigen receptor (CAR) T-cell therapy. It was subsequently adopted by the American Society for Transplantation and Cellular Therapy. The utility of CAPD as a screening tool for early diagnosis of ICANS has not been fully characterized. We conducted a retrospective study of pediatric and young adult patients (n=15) receiving standard-of-care CAR T-cell products. Cytokine release syndrome (CRS) and ICANS occurred in 87% and 40% of patients, respectively. ICANS was associated with significantly higher peaks of serum ferritin. A change in CAPD from a prior baseline was noted in 60% of patients with ICANS, 24–72 h prior to diagnosis of ICANS. The median change from baseline to maximum CAPD score of patients who developed ICANS versus those who did not was 13 versus 3, respectively (p=0.0004). Changes in CAPD score from baseline may be the earliest indicator of ICANS among pediatric and young adult patients which may warrant closer monitoring, with more frequent CAPD assessments.
KW - Cornell Assessment for Pediatric Delirium
KW - delirium
KW - immune effector cell
KW - immune effector cell neurotoxicity
KW - immune effector cell-associated neurotoxicity
UR - http://www.scopus.com/inward/record.url?scp=85102937358&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85102937358&partnerID=8YFLogxK
U2 - 10.3389/fonc.2021.634445
DO - 10.3389/fonc.2021.634445
M3 - Article
C2 - 33763368
AN - SCOPUS:85102937358
SN - 2234-943X
VL - 11
JO - Frontiers in Oncology
JF - Frontiers in Oncology
M1 - 634445
ER -