
Contents
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Introduction Introduction
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Clinical approach Clinical approach
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Neurological complications in the conditioning phase Neurological complications in the conditioning phase
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Drugs Drugs
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Posterior reversible encephalopathy syndrome Posterior reversible encephalopathy syndrome
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Complications during pancytopenia Complications during pancytopenia
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Infections Infections
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Post-transplant acute limbic encephalitis Post-transplant acute limbic encephalitis
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Transplantation-associated thrombotic microangiopathy Transplantation-associated thrombotic microangiopathy
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Engraftment syndrome Engraftment syndrome
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Seizures Seizures
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Immune reconstitution inflammatory syndrome Immune reconstitution inflammatory syndrome
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Neurological complications in the early post-transplantation period (2–6 months after transplantation) Neurological complications in the early post-transplantation period (2–6 months after transplantation)
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Infections Infections
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Aspergillosis Aspergillosis
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Toxoplasmosis gondii Toxoplasmosis gondii
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Varicella-zoster Varicella-zoster
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Progressive multifocal leukoencephalopathy Progressive multifocal leukoencephalopathy
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Other neurological complications Other neurological complications
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Late post-transplantation period (>6 months post-transplant) Late post-transplantation period (>6 months post-transplant)
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Graft-versus-host disease Graft-versus-host disease
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Neurological complications of adoptive T-cell therapies Neurological complications of adoptive T-cell therapies
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Immune effector cell-associated neurotoxicity syndrome Immune effector cell-associated neurotoxicity syndrome
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Clinical presentation of ICANS Clinical presentation of ICANS
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Management of patients with ICANS Management of patients with ICANS
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Treatment of ICANS Treatment of ICANS
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Outcomes of immune effector cell-associated neurotoxicity syndrome Outcomes of immune effector cell-associated neurotoxicity syndrome
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Conclusions Conclusions
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References References
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9 Neurological complications of cell therapies in haematological malignancies
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Published:July 2024
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Abstract
Cell therapies comprising haematological stem cell transplantation (HCT) and adoptive T-cell therapies (ACT) have become an essential part in the treatment of an expanding range haematological and non-haematological conditions. HCT involves the intravenous infusion of haematopoietic progenitor cells from the patient (autologous) or from a human leucocyte antigen (HLA)-matched donor (allogeneic). Prior to HTC, the patient typically undergoes high-dose preparative chemotherapy to eradicate residual malignant cells and suppress the immune system. After allogeneic HCT, it is essential to prevent graft rejection and graft-versus-host disease. Management of neurological complications after HCT is challenging. Complications may result from a wide range of factors, including drug-related toxicities, infections from fungi, bacteria, or viruses, metabolic encephalopathies, and immune-mediated disorders, as well as disease recurrence. Neurotoxicity associated with immune effector cell therapy such as chimeric antigen receptor (CAR)-T-cell and bispecific T-cell engager (BiTE) treatments is classified as immune effector cell-associated neurotoxicity syndrome (ICANS). ICANS may develop days to weeks following immune effector cell therapy. It may present as non-localizing symptoms, such as encephalopathy, memory loss and headaches, as well as with focal neurological deficits, including, hemiparesis, ataxia, weakness, and aphasia. Rapid recognition and timely treatment of these neurological complications are essential to reduce the risk of permanent neurological deficits and death.
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