Immune effector cell-associated neurotoxicity syndrome (ICANS) is an encephalopathy associated with systemic inflammation. It is commonly associated with CRS but can occasionally present with other systemic inflammation syndromes. It often presents in the first 4 days following onset of CRS, but can occur many weeks after CAR-T therapy. ICANS may be present in up to 60% of CAR-T patients, and may last for several weeks. The pathophysiology of ICANS is poorly understood1.
Symptoms and signs of ICANS can be subtle and may fluctuate but might include5:
- Language abnormalities including dysgraphia or expressive dysphasia, with an evolving aphasia being suggestive of ICANS
- Movement abnormalities including tremor, fine motor impairment asterixis or myoclonus
- Consciousness impairment with lethargy or inattention
- Seizures
- Autonomic instability
- Focal or generalised weakness
- Clinical features of cerebral oedema
Laboratory findings in ICANS are nonspecific; unlike in CRS, C-reactive protein levels do not correlate well with ICANS. Consumptive coagulopathy may be present and can complicate management.
