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Incidence and severity of ICANS following CAR-T therapy in patients previously receiving ifosfamide

Bone Marrow Transplantation volume 58, pages 219–221 (2023)Cite this article

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Many patients who receive chimeric antigen receptor T-cell (CAR-T) therapy for large B-cell lymphoma receive ifosfamide as a part of salvage treatment prior to CAR-T infusion. Neurotoxicity is an established adverse effect of both ifosfamide and CAR-T therapy [1,2,3,4]. To our knowledge, there is no published literature to date evaluating the potential relationship between the incidence and severity of immune effector cell-associated neurotoxicity syndrome (ICANS) after CAR-T therapy in patients who previously received ifosfamide and experienced ifosfamide-associated neurotoxicity.

We hereby summarize our single-center experience using ifosfamide with carboplatin, etoposide, and rituximab (R-ICE) followed by CAR-T therapy for treatment of aggressive large B-cell lymphomas. Ten patients received R-ICE followed by CAR-T therapy; of whom, four patients developed any grade ICANS following CAR-T therapy infusion. All patients received fludarabine 30 mg/m2/day and cyclophosphamide 500 mg/m2/day on day −5 to −3 prior to CAR-T infusion, and each patient received levetiracetam 500 mg every 12 hours for seizure prophylaxis from day −5. The American Society for Transplantation and Cellular Therapy Consensus Grading For Adults was used to assess cytokine release syndrome (CRS) and ICANS [3]. Patient data are summarized in Table 1.

Table 1 Patient data summary.
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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

References

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Authors and Affiliations

  1. Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA

    Hunter Sowell, Katie Gatwood & Matthew Perciavalle

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  1. Hunter Sowell
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  2. Katie Gatwood
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  3. Matthew Perciavalle
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Contributions

HS was responsible for reviewing patient charts to identify pertinent information to be included in the case report, writing the original manuscript, editing the manuscript, and manuscript submission. KG and MP identified the patient cases to be included in the case report, provided feedback on the manuscript, and edited the manuscript.

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Correspondence to Hunter Sowell.

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The authors declare no competing interests.

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Sowell, H., Gatwood, K. & Perciavalle, M. Incidence and severity of ICANS following CAR-T therapy in patients previously receiving ifosfamide. Bone Marrow Transplant 58, 219–221 (2023). https://doi.org/10.1038/s41409-022-01873-6

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  • DOI: https://doi.org/10.1038/s41409-022-01873-6

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