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IMS 2025 | The non-native English speaker ICE (NICE) score for patients with myeloma receiving cellular therapy
Grace Ferri, MD, Beth Israel Deaconess Medical Center, Boston, MA, comments on the need for a modified neurotoxicity metric in patients with multiple myeloma receiving cellular therapies, particularly those with diverse linguistic and educational backgrounds. She explains that a survey of hospital staff revealed concerns that the current immune effector cell-associated encephalopathy (ICE) score sometimes led to harmful interventions, especially in non-native English speakers. This prompted the development of a tailored alternative – the non-native English speaker ICE (NICE) score. This interview took place at the 22nd International Myeloma Society (IMS) Annual Meeting in Toronto, Canada.
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Transcript
So I just finished up residency at Boston Medical Center and Boston Medical Center is a big safety-net hospital. So we took care of a lot of patients who spoke different languages and had different educational backgrounds. And in that setting over the past year or two, we started implementing cellular therapies more and more in the inpatient setting. So we as residents started to notice that patients in whom we were concerned about neurotoxicity, a lot of those patients were non-native English speakers, or maybe some of those patients had a mild cognitive impairment at baseline...
So I just finished up residency at Boston Medical Center and Boston Medical Center is a big safety-net hospital. So we took care of a lot of patients who spoke different languages and had different educational backgrounds. And in that setting over the past year or two, we started implementing cellular therapies more and more in the inpatient setting. So we as residents started to notice that patients in whom we were concerned about neurotoxicity, a lot of those patients were non-native English speakers, or maybe some of those patients had a mild cognitive impairment at baseline. So that made us think, how do we measure neurotoxicity in patients receiving cellular therapies when maybe they don’t fit the textbook. So we thought maybe there was a need to come up with a slightly modified way of measuring our neurotoxicity scores, our ICE score. Maybe there could be an adapted metric for people who don’t speak English as their first language, for patients who have cognitive impairment, who may have educational backgrounds that are different from what we traditionally consider to be normal. And it just felt like a fixable problem. So in order to do this, we did a survey of nurses, staff members, residents, faculty, and we tried to see what people thought about how accurate our current neurotoxicity standard, the ICE score, was in our particular patient population. And, scarily, a lot of people – the majority, 92 percent of our survey participants – thought that our current metric, our ICE score, often resulted in harmful interventions for patients, particularly those who don’t speak English as their first language. So, based on this, we were inspired to come up with a modified metric, a non-native English speaker ICE score, or a NICE score, and we worked with some neurologists to make sure that we were measuring the same cognitive domains. So now, based on our survey, based on the need for this, we’re hoping to validate our new metric, our NICE score, hopefully in a larger population.
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