Brain: what are the neurotoxicity of car T cell therapy?

May 17, 2019 news / bioin / - recently appeared chimeric antigen receptor (car) T cell therapy has completely changed the clinical treatment of cancer Under the umbrella of immunotherapy, car T cell therapy trains and strengthens the patient's own immune system to attack tumors Early success in clinical trials resulted in the approval of treatment for recurrent blood cancers, including leukemia and lymphoma Despite the success of car T cell therapy, there is a risk of serious side effects These include neurotoxicity, which can lead to headaches, confusion and madness, as well as other neurological changes These debilitating effects are still poorly understood A team at the Brigham and women's hospital recently classified neurological symptoms in patients treated with car-t cells to better understand their neurotoxic side effects Although neurological symptoms are common (77% of patients have at least one symptom), they are transient The results were published in the journal Brain Source: http://cn.bing.com "the mechanism of neurotoxicity related to car T cells is unclear, and symptoms are difficult to predict," said Daniel Rubin, MD, Department of Neurology, Brigham University, the lead author of the study "We conducted this study to better define the specific neurological symptoms experienced by patients after treatment with car T cells "To identify the clinical symptoms of car-t-related neurotoxicity, the team conducted an observational cohort study of 100 patients with lymphomas admitted to Dana Farber / Brigham and women's cancer cell for car T-cell therapy between 2015 and 2018 The team evaluated the symptoms from the beginning of the car T-cell therapy infusion to two months after infusion In addition, all diagnostic assessments, including laboratory tests and imaging scans, were reviewed "We shared some clinical cases of early treatment, which are very serious and unusual from a neurological point of view," said Dr henrikas vaitkevicius, senior author of Neurology "This has stimulated our interest in working with the tumor and T cell treatment teams to allow us to assess most patients prospectively, rather than retrospectively "Their findings reveal the prevalence of neurological symptoms after car-t treatment The most common symptom is encephalopathy, a disorder of the brain that causes confusion, but there are other symptoms, such as headache, tremor, weakness, and language disorders Importantly, most of these effects are reversible and symptoms almost always disappear over time In addition, researchers found a unique pattern of activity or inactivity in their study Treatment-related neurological disorders often originate in areas where metabolic function appears to be inactive This finding is of great significance to the clinical evaluation and imaging application of neurotoxicity "Although neurological symptoms are common, imaging studies such as MRI, which are the basis of neurological diagnosis, are almost always normal," Rubin said In contrast, more direct diagnostic studies, such as EEG and pet, can reliably detect and predict neural dysfunction "Next, the researchers will establish and validate a model to more accurately evaluate and diagnose car-t-related neurotoxicity Reference: Daniel B Rubin et al, neurologic toxicities associated with Chinese antigen receiver T-cell therapy, brain (2019) Doi: 10.1093/brain/awz053