What are the neurologic adverse effects of chimeric antigen receptor (CAR) T-cell therapy?

Updated: May 04, 2018
  • Author: Sameh Gaballa, MD, MS; Chief Editor: Emmanuel C Besa, MD  more...
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The mechanism resulting in neurologic toxicity after CAR T-cell therapy is poorly understood. Neurologic toxicities can be mild to moderate (eg, headache, confusion, dysmetria, ataxia, dysphasia, tremors), but can also be severe and life-threatening (eg, seizures, coma requiring intubation and mechanical ventilation for airway protection).

The incidence of neurologic toxicity in published reports varies from 0% to 50%. [3, 23, 24]  Moreover, neurologic events may occur independent of CRS, [3]  which suggests that neurologic toxicity results from a mechanism different from CRS. Several groups have found anti-CD19 CAR T-cells with elevated IL-6 levels in the CSF in patients who developed neurotoxicity. [3, 24, 25]  However, neurotoxicity is not exclusive to CAR T-cell therapy and has also been reported with other immunotherapies such as blinatumumab. [26]

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