ArticleBlood advances2021
Fatal late-onset CAR T-cell-mediated encephalitis after axicabtagene-ciloleucel in a patient with large B-cell lymphoma.
Article in Blood advances, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 22 citations in OpenAlex.
- Markedly Delayed Onset ICANS in the Setting of CAR T-Cell-Mediated Aseptic Meningoencephalitis: Two Cases.The Neurohospitalist · 2026Article
- Immune Effector Cell-Associated Neurotoxicity Delayed Relapse After Chimeric Antigen Receptor T-Cell Therapy: A Case Report.Neurology(R) neuroimmunology & neuroinflammation · 2026Article
- Progressive Multifocal Leukoencephalopathy in Chimeric Antigen Receptor T-Cell Therapy Recipients: A Case Study.Journal of the advanced practitioner in oncology · 2025Article
- Utility of CSF IL-6 monitoring in managing ICANS associated with Epcoritamab treatment: a case report and literature review.Journal of clinical and experimental hematopathology : JCEH · 2025Review
- Late complications and long-term care of adult CAR T-cell patients.Hematology. American Society of Hematology. Education Program · 2024Review
- Prolonged severe cytopenia followed by fatal CAR T-cell-mediated encephalitis in a patient with acute lymphoblastic leukemia.Blood cell therapy · 2024Article
- The critical role of endothelial cell in the toxicity associated with chimeric antigen receptor T cell therapy and intervention strategies.Annals of hematology · 2024Review
- Case report: Rapid resolution of grade IV ICANS after first line intrathecal chemotherapy with methotrexate, cytarabine and dexamethasone.Frontiers in immunology · 2024Article
- Neurotoxicity of Cancer Immunotherapies Including CAR T Cell Therapy.Current neurology and neuroscience reports · 2023Review
- Molecular monitoring of T-cell kinetics and migration in severe neurotoxicity after real-world CD19-specific chimeric antigen receptor T cell therapy.Haematologica · 2023Article
- Blood-brain barrier breakdown, central nervous system cell damage, and infiltrated T cells as major adverse effects in CAR-T-related deaths: a literature review.Frontiers in medicine · 2023Review
- EASIX and Severe Endothelial Complications After CD19-Directed CAR-T Cell Therapy-A Cohort Study.Frontiers in immunology · 2022Article
Corrections and comments
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Authors and funding
11 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Treatment with CD19-directed (CAR) T cells has evolved as a standard of care for multiply relapsed or refractory large B-cell lymphoma (r/r LBCL). A common side effect of this treatment is the immune effector cell-associated neurotoxicity syndrome (ICANS). Severe ICANS can occur in up to 30% to 40% of patients treated with axicabtagene-ciloleucel (axi-cel), usually within the first 4 weeks after administration of the dose and usually responding well to steroids. We describe a case of progressive central neurotoxicity occurring 9 months after axi-cel infusion in a patient with r/r LBCL who had undergone a prior allogeneic hematopoietic cell transplant. Despite extensive systemic and intrathecal immunosuppression, neurological deterioration was inexorable and eventually fatal within 5 months. High CAR T-cell DNA copy numbers and elevated levels of interleukin-1 (IL-1) and IL-6 were found in the cerebral spinal fluid as clinical symptoms emerged, and CAR T-cell brain infiltration was observed on autopsy, suggesting that CAR T cells played a major pathogenetic role. This case of unexpected, devastating, late neurotoxicity warrants intensified investigation of neurological off-target effects of CD19-directed CAR T cells and highlights the need for continuous monitoring for late toxicities in this vulnerable patient population.
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