Bianca D. Santomasso, MD, PhD, assistant attending neurologist, Memorial Sloan Kettering Cancer Center, discusses how she prevents central nervous system toxicity due to CAR T-cell therapy for aggressive B-cell lymphoma in her own practice.
Santomasso and her colleagues perform the Immune Effector Cell Encephalopathy (ICE) screening at least once daily on patients who have received CAR T-cell therapy. The perfect score on ICE is 10 and when a patient’s score drops to 9, they start to be monitored more closely.
Severe cases of neurotoxicity can progress beyond language and disorientation to seizures and even falling into a coma, explains Santomasso. When patients have severe toxicity, they are given corticosteroids. Santomasso is unsure how the corticosteroids reverse the toxicity, but she believes they prevent the most severe progression as the toxicity runs its course. Some patients spontaneously recover without steroids, but corticosteroids are usually given to be safe. In Santomasso’s experience, giving corticosteroids has not changed the efficacy of treatment, though it is a subject being actively researched.