Neurologist-focused workflows for immune effector cell-associated neurotoxicity syndrome in CAR T-cell therapy and CD3-engaging bispecific antibodies
- 1University of Hail College of Medicine
- 2Almaarefa University College of Medicine
Abstract
Objective: To synthesize current evidence into a neurologist-focused workflow for early recognition, bedside monitoring, diagnostic triage, mitigation, and therapy-specific surveillance of immune effector cell-associated neurotoxicity syndrome (ICANS).
Methods: PubMed/MEDLINE, Scopus, Web of Science Core Collection, and Google Scholar were searched in English from inception through 25 March 2026. Of 201 records, 18 duplicates were removed, 183 were screened, 157 full texts were assessed, and 26 studies were included in a narrative synthesis. The selection process was reported using applicable PRISMA 2020 elements and the narrative presentation was evaluated using SANRA.
Results: Evidence supports early neurologic co-management in selected high-risk patients, serial language- and attention-sensitive bedside assessment, and clinically triggered rather than routine electroencephalography. Pilot neurocognitive data suggest that subtle decline may precede deterioration on the Immune Effector Cell-Associated Encephalopathy (ICE) score. Bispecific-antibody programs generally show lower neurotoxicity burdens than many CAR T-cell platforms but create repeated risk windows around step-up dosing and outpatient transition. Delayed B-cell maturation antigen (BCMA)-associated movement and neurocognitive syndromes remain an important safety signal, although therapeutic evidence is largely observational or case based.
Conclusion: The evidence supports documenting a baseline neurologic phenotype, performing serial bedside monitoring, deploying electroencephalography and neuroimaging when results may change management, and maintaining product-specific vigilance for delayed syndromes. Tiered pathways are needed for community and resource-limited settings.
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BibTeX
@article{alesefir2026neurologistfocused,
title = {{Neurologist-focused workflows for immune effector cell-associated neurotoxicity syndrome in CAR T-cell therapy and CD3-engaging bispecific antibodies}},
author = {Walid Alesefir and Mariam Hejazi and Basil Alashger and Abdulrahman Abodahab and Menna Abdelrazek and Karma Abouelnaga and Sara Koudeimati and Abdullah Alshibani and Lara Aljohani},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1903348},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1903348/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Neurologist-focused workflows for immune effector cell-associated neurotoxicity syndrome in CAR T-cell therapy and CD3-engaging bispecific antibodies
AU - Walid Alesefir
AU - Mariam Hejazi
AU - Basil Alashger
AU - Abdulrahman Abodahab
AU - Menna Abdelrazek
AU - Karma Abouelnaga
AU - Sara Koudeimati
AU - Abdullah Alshibani
AU - Lara Aljohani
PY - 2026
DA - 2026/10/14
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1903348
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1903348/full
AB - Objective: To synthesize current evidence into a neurologist-focused workflow for early recognition, bedside monitoring, diagnostic triage, mitigation, and therapy-specific surveillance of immune effector cell-associated neurotoxicity syndrome (ICANS). Methods: PubMed/MEDLINE, Scopus, Web of Science Core Collection, and Google Scholar were searched in English from inception through 25 March 2026. Of 201 records, 18 duplicates were removed, 183 were screened, 157 full texts were assessed, and 26 studies were included in a narrative synthesis. The selection process was reported using applicable PRISMA 2020 elements and the narrative presentation was evaluated using SANRA. Results: Evidence supports early neurologic co-management in selected high-risk patients, serial language- and attention-sensitive bedside assessment, and clinically triggered rather than routine electroencephalography. Pilot neurocognitive data suggest that subtle decline may precede deterioration on the Immune Effector Cell-Associated Encephalopathy (ICE) score. Bispecific-antibody programs generally show lower neurotoxicity burdens than many CAR T-cell platforms but create repeated risk windows around step-up dosing and outpatient transition. Delayed B-cell maturation antigen (BCMA)-associated movement and neurocognitive syndromes remain an important safety signal, although therapeutic evidence is largely observational or case based. Conclusion: The evidence supports documenting a baseline neurologic phenotype, performing serial bedside monitoring, deploying electroencephalography and neuroimaging when results may change management, and maintaining product-specific vigilance for delayed syndromes. Tiered pathways are needed for community and resource-limited settings.
SN - 1664-2295
ER -