Evidence map›Paper›PMID 37059470›Full record

ArticleNeurology(R) neuroimmunology & neuroinflammation2023

Frontal Intermittent Rhythmic Delta Activity Is a Useful Diagnostic Tool of Neurotoxicity After CAR T-Cell Infusion.

Sophie Huby, Philippe Gelisse, Jean-Jacques Tudesq, Pierre Labauge, Claire Duflos, Guillaume Cartron, Marc-Antoine Gallerand, Laura Platon, Stephanie Badiou, Sylvain Lamure and 3 more

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In one paragraph

Article in Neurology(R) neuroimmunology & neuroinflammation, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
4.1field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 18 citations in OpenAlex.

  1. Article
  2. Review
  3. The neurotoxic legacy of CAR-T cells: where do we stand?Therapeutic advances in neurological disorders · 2026
    Review
  4. Review
  5. Review
  6. Article
  7. Primary vs. pre-emptive anti-seizure medication prophylaxis in anti-CD19 CAR T-cell therapy.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2024
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 1 institution in 1 country.

Sophie HubyFrom the Department of Neurology (S.H., P.G., P.L., M.-A.G., X.A., G.T.), CHU Montpellier; Clinical Research and Epidemiology Unit (C.D.), CHU Montpellier; Department of Hematology (J.-J.T., G.C., S.L.), CHU Montpellier; Department of Intensive Care (L.P.), CHU Montpellier; Department of Biochemistry and Hormonology (S.B.), CHU Montpellier; Department of Neuroradiology (N.M.C.), CHU Montpellier, University of Montpellier; University of Montpellier (X.A.), INSERM (INM), Department of Neurology, Montpellier University Hospital; and University of Montpellier (G.T.), CNRS (IGF), Department of Neurology, Montpellier University Hospital, France. sophie.huby27@gmail.com.
Philippe GelisseFrom the Department of Neurology (S.H., P.G., P.L., M.-A.G., X.A., G.T.), CHU Montpellier; Clinical Research and Epidemiology Unit (C.D.), CHU Montpellier; Department of Hematology (J.-J.T., G.C., S.L.), CHU Montpellier; Department of Intensive Care (L.P.), CHU Montpellier; Department of Biochemistry and Hormonology (S.B.), CHU Montpellier; Department of Neuroradiology (N.M.C.), CHU Montpellier, University of Montpellier; University of Montpellier (X.A.), INSERM (INM), Department of Neurology, Montpellier University Hospital; and University of Montpellier (G.T.), CNRS (IGF), Department of Neurology, Montpellier University Hospital, France.
Jean-Jacques TudesqFrom the Department of Neurology (S.H., P.G., P.L., M.-A.G., X.A., G.T.), CHU Montpellier; Clinical Research and Epidemiology Unit (C.D.), CHU Montpellier; Department of Hematology (J.-J.T., G.C., S.L.), CHU Montpellier; Department of Intensive Care (L.P.), CHU Montpellier; Department of Biochemistry and Hormonology (S.B.), CHU Montpellier; Department of Neuroradiology (N.M.C.), CHU Montpellier, University of Montpellier; University of Montpellier (X.A.), INSERM (INM), Department of Neurology, Montpellier University Hospital; and University of Montpellier (G.T.), CNRS (IGF), Department of Neurology, Montpellier University Hospital, France.ORCID 0000-0003-4879-8106
Pierre LabaugeFrom the Department of Neurology (S.H., P.G., P.L., M.-A.G., X.A., G.T.), CHU Montpellier; Clinical Research and Epidemiology Unit (C.D.), CHU Montpellier; Department of Hematology (J.-J.T., G.C., S.L.), CHU Montpellier; Department of Intensive Care (L.P.), CHU Montpellier; Department of Biochemistry and Hormonology (S.B.), CHU Montpellier; Department of Neuroradiology (N.M.C.), CHU Montpellier, University of Montpellier; University of Montpellier (X.A.), INSERM (INM), Department of Neurology, Montpellier University Hospital; and University of Montpellier (G.T.), CNRS (IGF), Department of Neurology, Montpellier University Hospital, France.
Claire DuflosFrom the Department of Neurology (S.H., P.G., P.L., M.-A.G., X.A., G.T.), CHU Montpellier; Clinical Research and Epidemiology Unit (C.D.), CHU Montpellier; Department of Hematology (J.-J.T., G.C., S.L.), CHU Montpellier; Department of Intensive Care (L.P.), CHU Montpellier; Department of Biochemistry and Hormonology (S.B.), CHU Montpellier; Department of Neuroradiology (N.M.C.), CHU Montpellier, University of Montpellier; University of Montpellier (X.A.), INSERM (INM), Department of Neurology, Montpellier University Hospital; and University of Montpellier (G.T.), CNRS (IGF), Department of Neurology, Montpellier University Hospital, France.
Guillaume CartronFrom the Department of Neurology (S.H., P.G., P.L., M.-A.G., X.A., G.T.), CHU Montpellier; Clinical Research and Epidemiology Unit (C.D.), CHU Montpellier; Department of Hematology (J.-J.T., G.C., S.L.), CHU Montpellier; Department of Intensive Care (L.P.), CHU Montpellier; Department of Biochemistry and Hormonology (S.B.), CHU Montpellier; Department of Neuroradiology (N.M.C.), CHU Montpellier, University of Montpellier; University of Montpellier (X.A.), INSERM (INM), Department of Neurology, Montpellier University Hospital; and University of Montpellier (G.T.), CNRS (IGF), Department of Neurology, Montpellier University Hospital, France.
Marc-Antoine GallerandFrom the Department of Neurology (S.H., P.G., P.L., M.-A.G., X.A., G.T.), CHU Montpellier; Clinical Research and Epidemiology Unit (C.D.), CHU Montpellier; Department of Hematology (J.-J.T., G.C., S.L.), CHU Montpellier; Department of Intensive Care (L.P.), CHU Montpellier; Department of Biochemistry and Hormonology (S.B.), CHU Montpellier; Department of Neuroradiology (N.M.C.), CHU Montpellier, University of Montpellier; University of Montpellier (X.A.), INSERM (INM), Department of Neurology, Montpellier University Hospital; and University of Montpellier (G.T.), CNRS (IGF), Department of Neurology, Montpellier University Hospital, France.
Laura PlatonFrom the Department of Neurology (S.H., P.G., P.L., M.-A.G., X.A., G.T.), CHU Montpellier; Clinical Research and Epidemiology Unit (C.D.), CHU Montpellier; Department of Hematology (J.-J.T., G.C., S.L.), CHU Montpellier; Department of Intensive Care (L.P.), CHU Montpellier; Department of Biochemistry and Hormonology (S.B.), CHU Montpellier; Department of Neuroradiology (N.M.C.), CHU Montpellier, University of Montpellier; University of Montpellier (X.A.), INSERM (INM), Department of Neurology, Montpellier University Hospital; and University of Montpellier (G.T.), CNRS (IGF), Department of Neurology, Montpellier University Hospital, France.
Stephanie BadiouFrom the Department of Neurology (S.H., P.G., P.L., M.-A.G., X.A., G.T.), CHU Montpellier; Clinical Research and Epidemiology Unit (C.D.), CHU Montpellier; Department of Hematology (J.-J.T., G.C., S.L.), CHU Montpellier; Department of Intensive Care (L.P.), CHU Montpellier; Department of Biochemistry and Hormonology (S.B.), CHU Montpellier; Department of Neuroradiology (N.M.C.), CHU Montpellier, University of Montpellier; University of Montpellier (X.A.), INSERM (INM), Department of Neurology, Montpellier University Hospital; and University of Montpellier (G.T.), CNRS (IGF), Department of Neurology, Montpellier University Hospital, France.ORCID 0000-0001-6128-8114
Sylvain LamureFrom the Department of Neurology (S.H., P.G., P.L., M.-A.G., X.A., G.T.), CHU Montpellier; Clinical Research and Epidemiology Unit (C.D.), CHU Montpellier; Department of Hematology (J.-J.T., G.C., S.L.), CHU Montpellier; Department of Intensive Care (L.P.), CHU Montpellier; Department of Biochemistry and Hormonology (S.B.), CHU Montpellier; Department of Neuroradiology (N.M.C.), CHU Montpellier, University of Montpellier; University of Montpellier (X.A.), INSERM (INM), Department of Neurology, Montpellier University Hospital; and University of Montpellier (G.T.), CNRS (IGF), Department of Neurology, Montpellier University Hospital, France.ORCID 0000-0001-5980-305X
Nicolas Menjot de ChampfleurFrom the Department of Neurology (S.H., P.G., P.L., M.-A.G., X.A., G.T.), CHU Montpellier; Clinical Research and Epidemiology Unit (C.D.), CHU Montpellier; Department of Hematology (J.-J.T., G.C., S.L.), CHU Montpellier; Department of Intensive Care (L.P.), CHU Montpellier; Department of Biochemistry and Hormonology (S.B.), CHU Montpellier; Department of Neuroradiology (N.M.C.), CHU Montpellier, University of Montpellier; University of Montpellier (X.A.), INSERM (INM), Department of Neurology, Montpellier University Hospital; and University of Montpellier (G.T.), CNRS (IGF), Department of Neurology, Montpellier University Hospital, France.ORCID 0000-0002-4098-5962
Xavier AyrignacFrom the Department of Neurology (S.H., P.G., P.L., M.-A.G., X.A., G.T.), CHU Montpellier; Clinical Research and Epidemiology Unit (C.D.), CHU Montpellier; Department of Hematology (J.-J.T., G.C., S.L.), CHU Montpellier; Department of Intensive Care (L.P.), CHU Montpellier; Department of Biochemistry and Hormonology (S.B.), CHU Montpellier; Department of Neuroradiology (N.M.C.), CHU Montpellier, University of Montpellier; University of Montpellier (X.A.), INSERM (INM), Department of Neurology, Montpellier University Hospital; and University of Montpellier (G.T.), CNRS (IGF), Department of Neurology, Montpellier University Hospital, France.ORCID 0000-0003-3834-2981
Guillaume TaiebFrom the Department of Neurology (S.H., P.G., P.L., M.-A.G., X.A., G.T.), CHU Montpellier; Clinical Research and Epidemiology Unit (C.D.), CHU Montpellier; Department of Hematology (J.-J.T., G.C., S.L.), CHU Montpellier; Department of Intensive Care (L.P.), CHU Montpellier; Department of Biochemistry and Hormonology (S.B.), CHU Montpellier; Department of Neuroradiology (N.M.C.), CHU Montpellier, University of Montpellier; University of Montpellier (X.A.), INSERM (INM), Department of Neurology, Montpellier University Hospital; and University of Montpellier (G.T.), CNRS (IGF), Department of Neurology, Montpellier University Hospital, France.
Centre National de la Recherche Scientifique · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesChimeric antigen receptor (CAR) T-cell therapies have dramatically improved the prognosis of patients with relapsed or refractory hematologic malignancies; however, cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome (ICANS) occur in ∼100 and 50% of patients, respectively. This study aimed to determine whether EEG patterns may be considered as diagnostic tools for ICANS.

methodsPatients who received CAR T-cell therapy at Montpellier University Hospital between September 2020 and July 2021 were prospectively enrolled. Neurologic signs/symptoms and laboratory parameters were monitored daily for 14 days after CAR T-cell infusion. EEG and brain MRI were performed between day 6 and 8 after CAR T-cell infusion. EEG was performed again on the day of ICANS occurrence, if outside this time window. All collected data were compared between patients with and without ICANS.

resultsThirty-eight consecutive patients were enrolled (14 women; median age: 65 years, interquartile range: [55-74]). ICANS was observed in 17 of 38 patients (44%) after a median time of 6 days after CAR T-cell infusion (4-8). The median ICANS grade was 2 (1-3). Higher C-reactive protein peak (146 mg/L [86-256], DISCUSSION: FIRDA is a reliable diagnostic tool for ICANS, with a sensitivity of 88% and a negative predictive value of 100%. Moreover, as this EEG pattern disappeared concomitantly with ICANS resolution, FIRDA could be used to monitor neurotoxicity. Finally, our study suggests a pathogenic pathway that starts with increased C-reactive protein, followed by hyponatremia and eventually ICANS and FIRDA. More studies are required to confirm our results. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that FIRDA on spot EEG accurately distinguishes patients with ICANS compared with those without after CAR T-cell therapy for hematologic malignancy.

Indexed as

Delta RhythmHyponatremiaAgedC-Reactive ProteinFemaleHumansImmunotherapy, AdoptiveNeurotoxicity SyndromesT-Lymphocytescell-associated neurotoxicityC-Reactive Protein

Identifiers

PMID37059470
PMCPMC10119810
OpenAlexW4365811008

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