ASH 2024 | The potential impact of ICANS on long-term cognition in patients with DLBCL who have received CAR-T

Yeah, so this was wonderful work that was driven by one of our rising fellows at the University of Nebraska, Dr Olivia Makos. And what we observed in clinic is that there are some patients that just feel like cognitively they aren’t where they would like to be. And it’s kind of in some ways at a subclinical level. It’s not something that quite seems like it requires additional referral or a neurospecialist or anything like that. And yet our patients are experiencing this. So based on that, we wanted to take a look with a patient-reported outcome survey of patients and to describe their neurologic function in a truly patient-reported fashion to see if we could capture a sense of what’s going on there. In particular, we had hypothesized that there’s a potential that the ICANS toxicity is experienced by patients during CAR T-cell therapy. It might be that even though we think it resolves in the main symptoms that describe ICANS and the pattern of symptoms that lead to that presentation could go away, but there could be lingering effects that maybe don’t go away. And so we surveyed patients that are over a year out, because we were truly trying to capture this chronic component of it, a year from receiving their CAR T-cell therapy, and asked them to complete a survey on neurocognition. What surprised us is that when we started to look at those that had any ICANS toxicity compared to those that had no ICANS toxicity, the ones that had any kind of ICANS toxicity did report a trend towards increasing difficulty with some tasks of neurocognitive function, including attention to multiple kinds of tasks at any given time, remembering and things like that. It’s preliminary right now and this is just reported on 20 patients, but it’s encouraging enough to us that we think we should be exploring this more in a larger set to get a better sense of if there really is some degree of cognitive dysfunction and neurologic toxicity that endures despite resolution of ICANS for our patients receiving CAR T-cell therapy.

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