Authors
Andy Y Wang, Catherine Suen, Iyas Daghlas, Anupama Kumar, David Oh, Douglas Pet, Vanja Douglas
Published in
The Neurohospitalist. Pages 19418744261496340. Oct 12, 2026. Epub Oct 12, 2026.
Abstract
Immune effector cell-associated neurotoxicity syndrome (ICANS) typically manifests within the first week following chimeric antigen receptor (CAR) T-cell therapy and has rarely been described to develop beyond 1 month after treatment. This report describes the occurrence of markedly delayed ICANS in the setting of non-infectious meningoencephalitis.
We report two cases of markedly delayed ICANS with cerebrospinal fluid (CSF) pleocytosis comprised primarily of CAR T-cells.
Two patients, aged 54 and 67 years, developed ICANS at 71 and 46 days, respectively, following administration of ciltacabtagene autoleucel (cilta-cel), a B-cell maturation antigen (BCMA)-directed CAR T-cell therapy. CSF analysis demonstrated elevated total nucleated cell (TNC) counts of 1055 and 605 cells/μL, respectively, with marked lymphocytic predominance (94% and 90%), of which 90.4% and 95.4% were CAR T-cells. Both patients improved with corticosteroids and immunotherapy.
The identification of CAR T-cells in CSF analysis proved critical for clinical management, enabling early discontinuation of empiric meningeal antimicrobial therapy and implementation of targeted immunosuppressive treatment. This report highlights a rare presentation of markedly delayed ICANS associated with robust infiltration of CAR T-cells into the CSF, expanding our understanding of the temporal spectrum and pathophysiology of ICANS.
PMID:
42871407
Bibliographic data and abstract were imported from PubMed on 14 Oct 2026.
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