Researchers at Brigham and Women’s Hospital/Dana Farber Cancer Institute have developed a prognostic score, based on clinical and laboratory markers, that may help predict which patients are likely to experience neurotoxicity after chimeric antigen receptor (CAR) T-cell therapy, according to a paper published online in JAMA Neurology (2020;e202703. doi:10.1001/jamaneurol.2020.2703).
“CAR T-cell therapy for relapsed or refractory hematologic malignant neoplasm causes severe neurologic adverse events ranging from encephalopathy and aphasia to cerebral edema and death,” wrote Daniel B Rubin, MD, PhD, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, and colleagues.
“The cause of neurotoxicity is incompletely understood, and its unpredictability is a reason for prolonged hospitalization after CAR T-cell infusion,” they continued.
The study included 204 adults with relapsed or refractory lymphoma who received axicabtagene ciloleucel for CAR T-cell therapy at Brigham and Women’s Hospital/Dana Farber Cancer Institute between April 2015 and February 2020. Patients were separated into a derivation cohort (n = 126) and an internal validation cohort (n = 45).
The primary objective of the study was to identify clinical and laboratory parameters predictive of neurotoxicity and to develop a prognostic score associated with its risk.
Overall, 73 (57.9%) patients in the derivation cohort and 45 (57.7%) patients in the validation cohort experienced neurotoxicity.
A multivariable score was developed using clinical and laboratory values obtained early in admission. This score was used to predict subsequent neurotoxicity. When tested on the internal validation cohort, the prognostic score had an accuracy of 77%, a sensitivity of 82%, and a specificity of 70%.
“The score developed in this study may help predict which patients are likely to experience CAR T-cell–associated neurotoxicity. The score can be used for triaging and resource allocation and may allow a large proportion of patients to be discharged from the hospital early,” Dr Rubin and colleagues concluded.—Jolynn Tumolo
