Episode 78: CAR T-cell Therapy, ICANS, and other complications

CAR T-cell therapy complications beyond cytokine release syndrome primarily involve immune effector cell-associated neurotoxicity syndrome (ICANS), which affects 40% to 64% of patients within eight weeks of infusion. This neurotoxicity stems from blood-brain barrier disruption and presents through symptoms ranging from aphasia and seizures to coma. Management relies on the ICE scoring system, with treatment escalating from supportive care to high-dose dexamethasone and intracranial pressure management for severe grades. Beyond neurology, patients frequently face hematologic challenges, including neutropenia in 80% of cases and prolonged hypogammaglobulinemia. Cardiac toxicities, such as arrhythmias and heart failure, occur in nearly 39% of patients, often driven by IL-6 elevation or cross-reactivity with cardiac proteins. While graft versus host disease remains rare at less than 7%, the multisystem nature of these complications necessitates aggressive monitoring, specialist consultation, and targeted immunosuppression to manage life-threatening adverse effects.