Étude des toxicités neurologiques (ICANS) chez les patients atteints de lymphome B diffus à grandes cellules traités par CAR-T cells : expérience d'une cohorte bordelaise
Bibliographic record
Abstract
Introduction: chimeric Antigen Receptor (CAR) T cells, an innovative immunotherapy for refractory or relapsed B-cell lymphomas, are associated with frequent neurological toxicity, immune cell-associated neurotoxicity syndrome (ICANS). It is crucial to optimize the management of these patients by identifying risk factors and assessing the impact of treatments on CAR-T cell efficacy, as well as the long-term risk of neurological sequelae. Methods: we retrospectively studied 89 patients with diffuse large B-cell lymphoma treated with CAR-T cells between 2020 and 2024, and prospectively analyzed 16 patients who developed ICANS, followed in a remote neurological consultation. We examined their clinical, biological, imaging, and electroencephalographic characteristics, as well as the impact of corticosteroids on hematological response and survival. Results: of the 89 patients, 46% developed ICANS, of which 34% were severe and 56% were early-onset. Baseline ferritin and elevated lacticodeshydrogénase (LDH) levels, bridging therapy, and a poor response to bridging therapy were significantly associated with ICANS. Severe ICANS were linked to early cytokine release syndrome (CRS). Nearly 10% of patients experienced corticosteroid-dependent ICANS. Corticosteroids did not affect hematological response or mortality. The remote cognitive assessment showed a Montreal cognitive assessement (MoCA) score of 26.5/30, with a loss of 3 points, and 44% of patients reported cognitive sequelae. Discussion: our results are consistent with those of other real-life cohorts, showing neurotoxicity associated with a pro-inflammatory environment, including CRS and inflammatory biomarkers. Corticosteroids did not affect CAR-T cell response or mortality. Cognitive sequelae may persist. Larger studies are needed to refine management strategies for CAR-T cell-related toxicities.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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 source (direct Gemma or distilled Codex), 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".