Immune Effector Cell-Associated Neurotoxicity Syndrome of Chimeric Antigen Receptor T Cells: From Pathophysiology to Clinical Management

Chimeric antigen receptor (CAR)-T cell therapy has recently demonstrated promising outcomes for patients with malignant hematologic disorders. However, a significant number of these patients undergoing CAR-T cell therapy often present with symptoms of immune effector cell-associated neurotoxicity syndrome (ICANS), a common reason for their hospitalization and need for intensive care, thereby impacting the broader application of this therapy. The early detection of neurological symptoms, identification of specific biomarkers, and effective handling of ICANS are crucial for optimizing the efficacy of CAR-T cell therapy. This review delves into the underlying mechanisms of ICANS, the initial recognition of its clinical indicators, and the strategies for its clinical management.