Another study confirms use of EEG as a diagnostic tool to Manage CAR T-Cell Therapy Complications
From a recent publication called 'Impact of diagnostic investigations in the management of CAR T-cell-associated neurotoxicity': “Findings further validated the use of the electroencephalogram (EEG) – a noninvasive test measuring electrical activity in the brain – in managing this neurotoxicity.”
In this publication, the authors investigated the role of EEG, MRI and LP in management of immune effector cell-associated neurotoxicity syndrome (ICANS) in CAR-T cell-treated patients. International guidelines regarding the management of ICANS recommend several diagnostic investigations, including MRI, lumbar puncture (LP) and EEG based on ICANS grade. However, the impact of these investigations has not yet been evaluated.
“Our study shows that EEG is the diagnostic investigation with the greatest therapeutic impact while MRI and LP appear to have a limited therapeutic impact. Our results emphasize the role of EEG in the current guidelines, but questions the need for systematic MRI and LP, which might be left to the discretion of the treating physician.”
Impact of diagnostic investigations in the management of CAR T-cell-associated neurotoxicity
Key Points
-
Data from a large cohort of CAR-T cells-treated patients questions guidelines regarding diagnostic investigations in ICANS management.
-
Our results emphasize for the first time the role of EEG in the current guidelines, but questions the need for systematic MRI and LP.
Abstract
International guidelines regarding the management of immune effector cell-associated neurotoxicity syndrome (ICANS) recommend several diagnostic investigations, including MRI, lumbar puncture (LP) and EEG based on ICANS grade. However, the impact of these investigations has not yet been evaluated. Here, we aimed to describe the role of MRI, LP and EEG in the management of ICANS in a cohort of real-life patients treated with CAR T-cells at the University Hospital of Rennes, France. Between August 2018 and January 2023, 190 consecutive patients were treated with CAR T-cells. Among those, 91 (48%) patients developed ICANS. MRI was performed in 71 (78%) patients with ICANS, with a therapeutic impact in 4% of patients, despite frequent abnormal findings. Lumbar puncture was performed in 43 (47%) patients which led to preemptive antimicrobial agents in 7% of patients although no infection was eventually detected. Systematic EEG was performed in 51 (56%) patients which led to therapeutic modifications in 16% of patients. Our study shows that EEG is the diagnostic investigation with the greatest therapeutic impact while MRI and LP appear to have a limited therapeutic impact. Our results emphasize the role of EEG in the current guidelines, but questions the need for systematic MRI and LP, which might be left to the discretion of the treating physician.
Impact of diagnostic investigations in the management of CAR T-cell-associated neurotoxicity
Mattéo Mauget, Sophie Lemercier, Quentin Quelven, Adel Maamar, Faustine Lhomme, Sophie de Guibert, Houot Roch, Guillaume Manson
Blood Adv bloodadvances.2023011669.
https://doi.org/10.1182/bloodadvances.2023011669
DeltaScan and ICANS
Initial clinical data related to CAR T-cell therapy shows our device could also enhance patient treatment protocols by detecting early signs of ICANS. DeltaScan detected the condition 12–24 hours earlier than the standard approach and has the potential to improve outpatient monitoring.
In a recent poster presentation at the EBMT-EHA 6th European CAR T-cell Meeting in Valencia 'A Novel EEG-based DeltaWave Detection System for Early Identification of Immune Effector Cell-associated Neurotoxicity Syndrome (ICANS) in Patients Undergoing Chimeric Antigen Receptor (CAR) T-cell Treatment' by Tienstra et al. (2024), elevated DeltaScan scores were found to precede diminished ICE scores and the onset of ICANS, suggesting predictive potential for our technology.
