To analyze the viability of CAR T-cells in cerebrospinal fluid (CSF) of patients with grade ≥3 ICANS after CAR T-cell therapy.
Approach:
Key Findings:
Among 133 CAR T-cell recipients, 28 developed grade ≥3 ICANS and 13 underwent lumbar puncture.
Viable CAR T-cells were detected in all 11 evaluable CSF samples, with a median viability of 75%.
CAR T-cells remained detectable in CSF up to day +98 despite corticosteroid treatment.
Median CSF CAR T-cell count was 4.3/µL, with elevated protein and albumin indicating blood–CSF barrier disruption, suggesting significant clinical implications.
Interpretation:
This study is the first to demonstrate that viable CAR T-cells can be found in the CSF of patients with ICANS, even during corticosteroid therapy, highlighting the need for further investigation into their functional role.
Limitations:
Small sample size with only 13 patients undergoing lumbar puncture.
Retrospective nature may limit the generalizability of findings, introducing potential biases.
Conclusion:
The presence of viable CAR T-cells in CSF of ICANS patients suggests the need for further functional studies, particularly focusing on their role in neurotoxicity.
