The Neurocognitive Impact of CAR T Cell Therapy in Hematological Cancers: A Systematic Review of Cognitive Function, Quality of Life, and Psychological Outcomes
Bibliographic record
Abstract
Background: Chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment of hematological malignancies, offering durable remissions. However, concerns regarding its neurocognitive and psychological impact have emerged, particularly in patients experiencing immune effector cell-associated neurotoxicity syndrome (ICANS). Despite growing clinical use, the long-term effects on cognitive function, psychological well-being, and quality of life (QoL) remain unclear. Objective: This systematic review evaluates the neurocognitive, psychological, and QoL outcomes associated with CAR T-cell therapy. Methods: A systematic search of PubMed, Embase, and Scopus was conducted following PRISMA guidelines. Eligible studies included randomized controlled trials, cohort studies, and observational studies assessing cognitive function, psychological outcomes (anxiety, depression, PTSD), and QoL post-CAR T-cell therapy. Study quality was assessed using the Cochrane Risk of Bias Tool for RCTs and the Newcastle-Ottawa Scale for observational studies. Results: Eighteen studies met the inclusion criteria. Up to 44% of CAR T-cell recipients experienced cognitive impairments, particularly in memory, attention, and executive function. ICANS was reported in 25%-70% of patients, with severe ICANS in 10%-20%. Persistent cognitive deficits were observed beyond 12 months in a subset of patients, particularly those with severe ICANS. Psychological outcomes included anxiety and depression in 35% of patients, with PTSD reported in those experiencing severe neurotoxicity. While QoL improved over time, patients with prolonged neurotoxicity had delayed recovery. EEG-based biomarkers, including the EICANS Score, showed promise in predicting ICANS severity. Conclusions: CAR T-cell therapy is associated with neurocognitive and psychological sequelae, particularly in patients with severe ICANS. Long-term cognitive monitoring, standardized assessments, and targeted rehabilitation strategies are needed to optimize patient outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.006 | 0.001 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".