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

BACKGROUND AND OBJECTIVES: Chimeric 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 a...

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Autores principales: Huby, Sophie, Gelisse, Philippe, Tudesq, Jean-Jacques, Labauge, Pierre, Duflos, Claire, Cartron, Guillaume, Gallerand, Marc-Antoine, Platon, Laura, Badiou, Stephanie, Lamure, Sylvain, Menjot de Champfleur, Nicolas, Ayrignac, Xavier, Taieb, Guillaume
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10119810/
https://www.ncbi.nlm.nih.gov/pubmed/37059470
http://dx.doi.org/10.1212/NXI.0000000000200111
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author Huby, Sophie
Gelisse, Philippe
Tudesq, Jean-Jacques
Labauge, Pierre
Duflos, Claire
Cartron, Guillaume
Gallerand, Marc-Antoine
Platon, Laura
Badiou, Stephanie
Lamure, Sylvain
Menjot de Champfleur, Nicolas
Ayrignac, Xavier
Taieb, Guillaume
author_facet Huby, Sophie
Gelisse, Philippe
Tudesq, Jean-Jacques
Labauge, Pierre
Duflos, Claire
Cartron, Guillaume
Gallerand, Marc-Antoine
Platon, Laura
Badiou, Stephanie
Lamure, Sylvain
Menjot de Champfleur, Nicolas
Ayrignac, Xavier
Taieb, Guillaume
author_sort Huby, Sophie
collection PubMed
description BACKGROUND AND OBJECTIVES: Chimeric 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. METHODS: Patients 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. RESULTS: Thirty-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], p = 0.004) at day 4 (3–6), lower natremia (131 mmol/L [129–132], p = 0.005) at day 5 (3–6), and frontal intermittent rhythmic delta activity (FIRDA, p < 0.001) on EEG between days 6 and 8 after infusion were correlated with ICANS occurrence. FIRDA was only observed in patients with ICANS (N = 15/17, sensitivity of 88%) and disappeared after ICANS resolution, usually after steroid therapy. Except for hyponatremia, no other toxic/metabolic marker was associated with FIRDA (p = 0.002). The plasma concentration of copeptin, a surrogate marker of antidiuretic hormone secretion, assessed at day 7 after infusion, was significantly higher in patients with (N = 8) than without (N = 6) ICANS (p = 0.043). 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.
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spelling pubmed-101198102023-04-22 Frontal Intermittent Rhythmic Delta Activity Is a Useful Diagnostic Tool of Neurotoxicity After CAR T-Cell Infusion Huby, Sophie Gelisse, Philippe Tudesq, Jean-Jacques Labauge, Pierre Duflos, Claire Cartron, Guillaume Gallerand, Marc-Antoine Platon, Laura Badiou, Stephanie Lamure, Sylvain Menjot de Champfleur, Nicolas Ayrignac, Xavier Taieb, Guillaume Neurol Neuroimmunol Neuroinflamm Research Article BACKGROUND AND OBJECTIVES: Chimeric 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. METHODS: Patients 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. RESULTS: Thirty-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], p = 0.004) at day 4 (3–6), lower natremia (131 mmol/L [129–132], p = 0.005) at day 5 (3–6), and frontal intermittent rhythmic delta activity (FIRDA, p < 0.001) on EEG between days 6 and 8 after infusion were correlated with ICANS occurrence. FIRDA was only observed in patients with ICANS (N = 15/17, sensitivity of 88%) and disappeared after ICANS resolution, usually after steroid therapy. Except for hyponatremia, no other toxic/metabolic marker was associated with FIRDA (p = 0.002). The plasma concentration of copeptin, a surrogate marker of antidiuretic hormone secretion, assessed at day 7 after infusion, was significantly higher in patients with (N = 8) than without (N = 6) ICANS (p = 0.043). 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. Lippincott Williams & Wilkins 2023-04-14 /pmc/articles/PMC10119810/ /pubmed/37059470 http://dx.doi.org/10.1212/NXI.0000000000200111 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Research Article
Huby, Sophie
Gelisse, Philippe
Tudesq, Jean-Jacques
Labauge, Pierre
Duflos, Claire
Cartron, Guillaume
Gallerand, Marc-Antoine
Platon, Laura
Badiou, Stephanie
Lamure, Sylvain
Menjot de Champfleur, Nicolas
Ayrignac, Xavier
Taieb, Guillaume
Frontal Intermittent Rhythmic Delta Activity Is a Useful Diagnostic Tool of Neurotoxicity After CAR T-Cell Infusion
title Frontal Intermittent Rhythmic Delta Activity Is a Useful Diagnostic Tool of Neurotoxicity After CAR T-Cell Infusion
title_full Frontal Intermittent Rhythmic Delta Activity Is a Useful Diagnostic Tool of Neurotoxicity After CAR T-Cell Infusion
title_fullStr Frontal Intermittent Rhythmic Delta Activity Is a Useful Diagnostic Tool of Neurotoxicity After CAR T-Cell Infusion
title_full_unstemmed Frontal Intermittent Rhythmic Delta Activity Is a Useful Diagnostic Tool of Neurotoxicity After CAR T-Cell Infusion
title_short Frontal Intermittent Rhythmic Delta Activity Is a Useful Diagnostic Tool of Neurotoxicity After CAR T-Cell Infusion
title_sort frontal intermittent rhythmic delta activity is a useful diagnostic tool of neurotoxicity after car t-cell infusion
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10119810/
https://www.ncbi.nlm.nih.gov/pubmed/37059470
http://dx.doi.org/10.1212/NXI.0000000000200111
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