Identifying Signs of Neurotoxicity From CAR T-Cell Therapy

While CAR T-cell therapy can be a major benefit for patients resistant to other treatments, it is not without its own toxicities to keep an eye on. One of these is neurotoxicity, usually following cytokine release syndrome (CRS).

At the 2019 School of Hematologic Oncology, OncLive^®, a sister publication of Oncology Nursing News^®, had the chance to speak with Bianca D. Santomasso, MD, PhD, assisting attending neurologist at Memorial Sloan Kettering Cancer Center in New York, New York, about what signs of neurotoxicity providers should watch out for.

TRANSCRIPTION

Neurotoxicity usually develops after CRS. It can kind of start around the same time as CRS, but it usually occurs after the patient's no longer have a fever, so it is important for people to be aware that the timing can be different. CRS usually happens around day 2 or 3 and neurotoxicity can happen around day 4, but as late as day 7 or 10, or even a little bit later.

It is primarily reversible; it usually takes place in the first couple of weeks after a therapy and it's interesting as the patients develop predominantly what can be classified as encephalopathy meaning that they just have disordered thinking and interactions. The most specific symptom we've seen is what is called aphasia, people have difficulty naming, speaking, their speech can be a little bit halting, so that seems to be the most specific first sign to watch out for.