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Abstract Details

A Retrospective Study of Subtle and Chronic Neurological Findings from CART in an Ethnically Diverse, Real-world Cohort
Neuro-oncology
P12 - Poster Session 12 (11:45 AM-12:45 PM)
6-004
The objective was to identify risk factors, acute neurologic signs, and neurologic outcomes in a minority-rich cohort of patients treated with chimeric antigen receptor T-cell (CART) therapy.
Though CART has emerged as a revolutionary treatment for relapsed or refractory B-cell malignancies, immune effector cell-associated neurotoxicity syndrome (ICANS) remains a significant complication with little trial data in minority populations. There is also a lack of understanding of signs of acute neurotoxicity outside of ICANS grading criteria, as well as signs of prolonged neurotoxicity.
We conducted a retrospective study of patients with B-cell lymphoma who received axicabtagene ciloleucel CART between June 2018 and July 2022 at a minority-rich hospital. Demographics, baseline functional status, CNS involvement, progression-free survival (PFS), overall survival (OS), ICANS grade, neurological findings, and neurologic outcomes were recorded for analysis.

Our sample consisted of 49 patients with an ethnic composition of 17 Hispanic, 14 Caucasian, 13 African American, 2 Asian, and 3 unspecified/other patients. Median OS was 48 months and median PFS was 22.3 months. 19 (39%) patients had ICANS > 0. There was no association between ICANS and any of the following variables: ECOG, KPS, sex, age, ethnicity, CNS involvement.

Among the 19 patients with ICANS > 0, neurologic deficits were seen in attention (16), language (15), orientation (13), abnormal movements (6), and motor strength (4). 2 patients had persistent cognitive deficits, and 6 died during hospitalization. 4 patients with ICANS 0 had subtle findings including motor apraxia, decreased fine motor movements, tremors, and sensory changes. Of those patients, 2 reported persistent hand tremors.
Out study supports a more nuanced neurological evaluation to identify subtle findings of neurotoxicity both peri-therapeutically and chronically. We also observed that 16% of cases experienced permanent neurotoxicity or death, a higher proportion than seen in clinical trials which do not traditionally enroll marginalized populations.
Authors/Disclosures
Samantha J. Cheng, MD
PRESENTER 		Dr. Cheng has nothing to disclose.
Elizabeth Zeldin, Medical Student Ms. Zeldin has nothing to disclose.
Kith Pradhan, PhD Dr. Pradhan has nothing to disclose.
NIshi Shah, MD Dr. Shah has nothing to disclose.
Dennis L. Cooper, MD Dr. Cooper has nothing to disclose.
Lauren C. Shapiro, MD Dr. Shapiro has nothing to disclose.
Kira Gritsman, MD, PhD The institution of Dr. Gritsman has received research support from NIH/NIDDK.
Katharine A. McNicol, MD (Montefiore Cancer Center) An immediate family member of Dr. McNicol has received personal compensation for serving as an employee of Siemens Healthineers.
Mark Milstein, MD, FAAN (Montefiore Medical Center) Dr. Milstein has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Milstein has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for various law firms. Dr. Milstein has received publishing royalties from a publication relating to health care. Dr. Milstein has a non-compensated relationship as a Board of Directors with New York County Medical Society that is relevant to AAN interests or activities.
R.Alejandro (Alex) A. Sica, MD The institution of Dr. Sica has received research support from Kite.