EEG als diagnostisch hulpmiddel om complicaties bij CAR T-celtherapie
Uit een recente publicatie '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.”
De auteurs van dit onderzoek hebben de rol van EEG, MRI en LP onderzocht bij de behandeling van het immuun effectoren cel-geassocieerde neurotoxiciteitssyndroom (ICANS) bij CAR-T cel-behandelde patiënten. Internationale richtlijnen voor het beheer van ICANS bevelen verschillende diagnostische onderzoeken aan, waaronder MRI, lumbaalpunctie (LP) en EEG op basis van de ICANS graad. Echter, de impact van deze onderzoeken is nog niet geëvalueerd.
“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
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Data from a large cohort of CAR-T cells-treated patients questions guidelines regarding diagnostic investigations in ICANS management.
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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
Uit de initiële klinische gegevens met betrekking tot CAR T-celtherapie blijkt dat ons apparaat ook de behandelingsprotocollen voor patiënten kan verbeteren door vroege tekenen van ICANS te detecteren. DeltaScan detecteerde de aandoening 12-24 uur eerder dan de standaard benadering en heeft het potentieel om de monitoring van poliklinische behandeling te verbeteren.
Uit een recente posterpresentatie op de EBMT-EHA 6e Europese CAR T-celbijeenkomst 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' door Tienstra et al. (2024) bleek dat verhoogde DeltaScan-scores voorafgaan aan verminderde ICE-scores en het begin van ICANS, wat wijst op het voorspellende potentieel van onze technologie.
