Magnetic resonance imaging (MRI) and lumbar puncture (LP) may not always be necessary for diagnosing and managing a serious neurological complication associated with CAR T-cell therapy, according to a new Blood Advances study.
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A study published in Blood Advances reveals that magnetic resonance imaging (MRI) and lumbar puncture (LP) may not be systematically necessary in the diagnosis and management of severe cases of neurotoxicity linked to CAR T cell therapy. Instead, electroencephalogram (EEG), a non-invasive test, has proved useful in the management of these complications. The researchers examined the usefulness of these tests in 190 patients treated with CAR-T at Rennes University Hospital, where during treatment around 48% of patients developed immune effector cell-associated neurotoxicity syndrome (ICANS). The researchers assessed how the different tests affected patient treatment, such as how medications, e.g. antibiotics and anti-epileptic treatments, were prescribed based on abnormal results, and how these treatments altered patient outcomes. The results ultimately revealed that abnormal findings were more common in patients with more severe ICANS. MRI findings were often normal, and although LP and EEG often showed abnormalities, they were more common in more severe cases of ICANS. When it came to therapeutic decisions, MRI rarely led to changes, LP sometimes led to unnecessary treatments in cases of suspected infections, and EEG often resulted in adjustments to antiepileptic drugs.