%0 Journal Article
%T Frontal Intermittent Rhythmic Delta Activity Is a Useful Diagnostic Tool of Neurotoxicity After CAR T-Cell Infusion.
%+ Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
%+ Université de Montpellier (UM)
%+ Institut Desbrest de santé publique (IDESP)
%+ Institut de Génétique Moléculaire de Montpellier (IGMM)
%+ Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp)
%+ Laboratoire Charles Coulomb (L2C)
%+ Institut des Neurosciences de Montpellier (INM)
%+ Institut de Génomique Fonctionnelle (IGF)
%A Huby, Sophie
%A Gelisse, Philippe
%A Tudesq, Jean‐jacques
%A Labauge, Pierre
%A Duflos, Claire
%A Duflos, Claire
%A Cartron, Guillaume
%A Gallerand, Marc-Antoine
%A Platon, Laura
%A Badiou, Stéphanie
%A Lamure, Sylvain
%A Menjot de Champfleur, Nicolas
%A Ayrignac, Xavier
%A Taieb, Guillaume
%< avec comité de lecture
%@ 2332-7812
%J Neurology Neuroimmunology & Neuroinflammation
%I American Academy of neurology
%V 10
%N 4
%P e200111
%8 2023-07
%D 2023
%R 10.1212/NXI.0000000000200111
%M 37059470
%Z Life Sciences [q-bio]
%Z Life Sciences [q-bio]/Human health and pathologyJournal articles
%X Background and objectives: Chimeric antigen receptor (CAR) T-cell therapies have dramatically improved the prognosis of patients with relapsed or refractory hematologic malignancies; however, cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome (ICANS) occur in ∼100 and 50% of patients, respectively. This study aimed to determine whether EEG patterns may be considered as diagnostic tools for ICANS.Methods: Patients who received CAR T-cell therapy at Montpellier University Hospital between September 2020 and July 2021 were prospectively enrolled. Neurologic signs/symptoms and laboratory parameters were monitored daily for 14 days after CAR T-cell infusion. EEG and brain MRI were performed between day 6 and 8 after CAR T-cell infusion. EEG was performed again on the day of ICANS occurrence, if outside this time window. All collected data were compared between patients with and without ICANS.Results: Thirty-eight consecutive patients were enrolled (14 women; median age: 65 years, interquartile range: [55-74]). ICANS was observed in 17 of 38 patients (44%) after a median time of 6 days after CAR T-cell infusion (4-8). The median ICANS grade was 2 (1-3). Higher C-reactive protein peak (146 mg/L [86-256], p = 0.004) at day 4 (3-6), lower natremia (131 mmol/L [129-132], p = 0.005) at day 5 (3-6), and frontal intermittent rhythmic delta activity (FIRDA, p < 0.001) on EEG between days 6 and 8 after infusion were correlated with ICANS occurrence. FIRDA was only observed in patients with ICANS (N = 15/17, sensitivity of 88%) and disappeared after ICANS resolution, usually after steroid therapy. Except for hyponatremia, no other toxic/metabolic marker was associated with FIRDA (p = 0.002). The plasma concentration of copeptin, a surrogate marker of antidiuretic hormone secretion, assessed at day 7 after infusion, was significantly higher in patients with (N = 8) than without (N = 6) ICANS (p = 0.043).Discussion: FIRDA is a reliable diagnostic tool for ICANS, with a sensitivity of 88% and a negative predictive value of 100%. Moreover, as this EEG pattern disappeared concomitantly with ICANS resolution, FIRDA could be used to monitor neurotoxicity. Finally, our study suggests a pathogenic pathway that starts with increased C-reactive protein, followed by hyponatremia and eventually ICANS and FIRDA. More studies are required to confirm our results.Classification of evidence: This study provides Class III evidence that FIRDA on spot EEG accurately distinguishes patients with ICANS compared with those without after CAR T-cell therapy for hematologic malignancy.
%G English
%2 https://hal.science/hal-04071772/document
%2 https://hal.science/hal-04071772/file/e200111.full.pdf
%L hal-04071772
%U https://hal.science/hal-04071772
%~ CNRS
%~ IGMM
%~ INM
%~ IGF
%~ L2C
%~ BS
%~ CHIMIE
%~ UNIV-MONTPELLIER
%~ PHYMEDEXP
%~ IDESP
%~ UM-2015-2021
%~ UM-EPE
%~ TEST3-HALCNRS