2018
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Clinical and Biological Correlates of Neurotoxicity Associated with CAR T-cell Therapy in Patients with B-cell Acute Lymphoblastic Leukemia
Abstract: CD19-specific chimeric antigen receptor (CAR) T-cell therapy is highly effective against relapsed or refractory acute lymphoblastic leukemia (ALL), but is hindered by neurotoxicity. In 53 adult patients with ALL, we found a significant association of severe neurotoxicity with high pretreatment disease burden, higher peak CAR T-cell expansion, and early and higher elevations of proinflammatory cytokines in blood. Patients with severe neurotoxicity had evidence of blood-cerebrospinal fluid (CSF) barrier disrupti… Show more
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“…We, therefore, believe that these factors are not major drivers of neurotoxicity and, at least, do not explain the difference in neurotoxicity rates between both studies. Although this is in sharp contrast with what has been observed in studies with CD19 CAR-T cells [60,61], this meta-analysis pointed to a higher risk of neurotoxicity in BCMA CAR-T-cell studies in which the median patient age was ≥ 60 years and/or in which the median number of prior lines of anti-myeloma treatments was ≥ 5. As shown in Table 2, LEGEND-2 (LCAR-B38M) tended to include younger and less pretreated patients, possibly explaining the lower frequency of neurological events as compared to KarMMa (bb2121).…”
Section: Discussioncontrasting
confidence: 99%
Exaggerated anticipatory anxiety is common in social anxiety disorder (SAD).
Neuroimaging studies have revealed altered neural activity in response to social stimuli in SAD, but fewer studies have examined neural activity during anticipation of feared social stimuli in SAD.
The current study examined the time course and magnitude of activity in threat processing brain regions during speech anticipation in socially anxious individuals and healthy controls (HC).
Method Participants (SAD n = 58; HC n = 16) underwent functional magnetic resonance imaging (fMRI) during which they completed a 90s control anticipation task and 90s speech anticipation task.
“…We, therefore, believe that these factors are not major drivers of neurotoxicity and, at least, do not explain the difference in neurotoxicity rates between both studies. Although this is in sharp contrast with what has been observed in studies with CD19 CAR-T cells [60,61], this meta-analysis pointed to a higher risk of neurotoxicity in BCMA CAR-T-cell studies in which the median patient age was ≥ 60 years and/or in which the median number of prior lines of anti-myeloma treatments was ≥ 5. As shown in Table 2, LEGEND-2 (LCAR-B38M) tended to include younger and less pretreated patients, possibly explaining the lower frequency of neurological events as compared to KarMMa (bb2121).…”
Section: Discussioncontrasting
confidence: 99%
Exaggerated anticipatory anxiety is common in social anxiety disorder (SAD).
Neuroimaging studies have revealed altered neural activity in response to social stimuli in SAD, but fewer studies have examined neural activity during anticipation of feared social stimuli in SAD.
The current study examined the time course and magnitude of activity in threat processing brain regions during speech anticipation in socially anxious individuals and healthy controls (HC).
Method Participants (SAD n = 58; HC n = 16) underwent functional magnetic resonance imaging (fMRI) during which they completed a 90s control anticipation task and 90s speech anticipation task.
“…CAR T cells was an unsuitable predictor of ICANS, as it reached its peak later than the median onset of the first neurological symptom. In accordance with current literature (11,12,15), we found that high-grade CRS is tightly associated with ICANS also in our case set (Table 1). However, in spite of higher day +1 CAR + EV levels in patients developing CRS, CAR + EVs turned out to be unsuitable predictors of its occurrence, owing to the overlapping with the median (day +1) onset of CRS.…”
Section: Discussionsupporting
confidence: 93%
Exaggerated anticipatory anxiety is common in social anxiety disorder (SAD).
Neuroimaging studies have revealed altered neural activity in response to social stimuli in SAD, but fewer studies have examined neural activity during anticipation of feared social stimuli in SAD.
The current study examined the time course and magnitude of activity in threat processing brain regions during speech anticipation in socially anxious individuals and healthy controls (HC).
Method Participants (SAD n = 58; HC n = 16) underwent functional magnetic resonance imaging (fMRI) during which they completed a 90s control anticipation task and 90s speech anticipation task.
“…In fact, proinflammatory cytokines in the CSF likely accumulate both from the circulating blood and from CNS production. 11 , 25 CAR-T cells were present in all CSF specimens from our patients, similar to previously reported findings. 28 , 29 Not all inflammatory cytokines were significantly elevated with CAR-T cell expansion in the CSF, however, suggesting that infiltrating CAR-T cells do not have a primary role in the development of ICANS.…”
Section: Discussionsupporting
confidence: 92%
Exaggerated anticipatory anxiety is common in social anxiety disorder (SAD).
Neuroimaging studies have revealed altered neural activity in response to social stimuli in SAD, but fewer studies have examined neural activity during anticipation of feared social stimuli in SAD.
The current study examined the time course and magnitude of activity in threat processing brain regions during speech anticipation in socially anxious individuals and healthy controls (HC).
Method Participants (SAD n = 58; HC n = 16) underwent functional magnetic resonance imaging (fMRI) during which they completed a 90s control anticipation task and 90s speech anticipation task.
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