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Review
. 2020 Apr/Jun;43(2):191-204.
doi: 10.1097/CNQ.0000000000000302.

CAR T-Cell-Associated Neurotoxicity: Current Management and Emerging Treatment Strategies

Amanda M Rivera  1 , Scott May, Matthew Lei, Stephanie Qualls, Katelyn Bushey, Daniel B Rubin, Megan E Barra
Affiliations
Review

CAR T-Cell-Associated Neurotoxicity: Current Management and Emerging Treatment Strategies

Amanda M Rivera et al. Crit Care Nurs Q. 2020 Apr/Jun.

Abstract

Axicabtagene ciloleucel and tisagenlecleucel are 2 chimeric antigen receptor (CAR) T-cell immunotherapies targeting CD19 for the treatment of B-cell acute lymphoblastic leukemia and non-Hodgkin lymphoma. Two commonly recognized complications associated with CAR T-cell therapies are cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). ICANS can occur in isolation or concomitantly with CRS following CAR T-cell therapy and may be due to disruption of the blood-brain barrier and the effects of elevated cytokine levels on the central nervous system. Presently, the optimum management of ICANS remains elusive, as there lacks consensus guidelines. The objective of this review is to provide a comprehensive summary of ICANS and strategies for prompt identification and management of patients presenting to the intensive care unit with this syndrome.

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References

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