Non-ICANS neurotoxicities CD19-directed CAR T-cell therapy and the emergence of movement and neurocognitive treatment-emergent adverse events: a case report - PubMed
9 hours ago
- #CAR T-cell therapy
- #case report
- #neurotoxicity
- A 63-year-old male with DLBCL developed delayed-onset neurotoxicity (MNTs) 22 days post CD19-directed CAR T-cell therapy (axi-cel).
- Symptoms included gait ataxia, hypokinetic movement disturbances (bradykinesia, rigidity, tremor), and cognitive slowing—resembling parkinsonism.
- First documented case of MNT-like syndrome following CD19-directed CAR T-cell therapy; previously reported only with BCMA-targeted CAR T products.
- No radiographic progression, infection, or lymphoma relapse observed. Immunophenotyping showed activated CD8+ T cells in blood and CAR T cells in CSF.
- Elevated neurofilament light chain (NfL) levels in serum/CSF indicated neuroaxonal injury. Steroids led to partial improvement, but neurocognitive deficits persisted.
- Highlights the need for expanded neurotoxicity monitoring beyond ICANS in CAR T-cell therapies, even for CD19 targets.