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<p>Immune effector cell-associated neurotoxicity syndrome (ICANS) is a serious early adverse event of chimeric antigen receptor T (CAR-T) cell therapy. ICANS typically occurs concurrently with or follows cytokine release syndrome (CRS), suggesting CRS can be considered the primary risk factor for ICANS onset. Therefore, CRS characteristics in an individual patient may predict their risk for subsequently developing ICANS. We analyzed 154 patients with B cell lymphoma treated with commercial CAR-T products between 2020 and 2024; 38 patients (24.7%) developed ICANS after CRS. The cohort was split into a derivation set and a validation set. In the derivation cohort, univariate analysis identified two CRS-related factors strongly associated with ICANS: CRS onset within 24h and grade 2–4 CRS by day 3. Using these two variables, we created a simple predictive model that stratified patients into high-, intermediate-, and low-risk groups, with ICANS incidences of 47.4%, 31.0%, and 8.2%, respectively. The validation cohort confirmed this trend. These findings suggest that early CRS characteristics provide a practical, clinically applicable method for estimating ICANS risk and may support timely management decisions in CAR-T therapy.</p>

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Early prediction of ICANS using CRS characteristics in B-cell lymphoma patients receiving CAR-T therapy

  • 期刊论文

  • 发表日期：

    2026年7月23日

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  • Hakuei Nishihara,
  • Fumiaki Jinnouchi,
  • Daisuke Ishihara,
  • Hiroshi Imanaga,
  • Kensuke Sasaki,
  • Teppei Sakoda,
  • Takuji Yamauchi,
  • Kohta Miyawaki,
  • Takahiro Shima,
  • Masatoshi Shimo,
  • Tomoko Henzan,
  • Yuya Kunisaki,
  • Yoshikane Kikushige,
  • Yasuo Mori,
  • Koichi Akashi,
  • Koji Kato

摘要

Immune effector cell-associated neurotoxicity syndrome (ICANS) is a serious early adverse event of chimeric antigen receptor T (CAR-T) cell therapy. ICANS typically occurs concurrently with or follows cytokine release syndrome (CRS), suggesting CRS can be considered the primary risk factor for ICANS onset. Therefore, CRS characteristics in an individual patient may predict their risk for subsequently developing ICANS. We analyzed 154 patients with B cell lymphoma treated with commercial CAR-T products between 2020 and 2024; 38 patients (24.7%) developed ICANS after CRS. The cohort was split into a derivation set and a validation set. In the derivation cohort, univariate analysis identified two CRS-related factors strongly associated with ICANS: CRS onset within 24h and grade 2–4 CRS by day 3. Using these two variables, we created a simple predictive model that stratified patients into high-, intermediate-, and low-risk groups, with ICANS incidences of 47.4%, 31.0%, and 8.2%, respectively. The validation cohort confirmed this trend. These findings suggest that early CRS characteristics provide a practical, clinically applicable method for estimating ICANS risk and may support timely management decisions in CAR-T therapy.