Lapidus Adam H, Anderson Mary Ann, Harrison Simon J, Dickinson Michael, Kalincik Tomas, Lasocki Arian
Melbourne Medical School, The University of Melbourne, Parkville, Australia.
Department of Medical Biology, The University of Melbourne, Parkville, Australia.
Leuk Lymphoma. 2022 Oct;63(10):2364-2374. doi: 10.1080/10428194.2022.2074990. Epub 2022 May 14.
Chimeric antigen receptor T-cell (CAR-T) therapy is a promising immunotherapy approved for hematological malignancies. Despite its effectiveness, clinically significant rates of toxicity, including immune effector cell associated neurotoxicity syndrome (ICANS), limit its widespread use. In certain contexts, ICANS may occur in up to one-third of patients using commercially available CAR-T therapies. The syndrome presents with a range of neurological signs and symptoms, as well as a variety of neuroimaging manifestations reported in the literature. A systematic review of the literature was performed. The systematic search strategy identified 24 studies discussing the neuroimaging appearances associated with ICANS. Imaging findings are more common in patients with higher grade neurotoxicity. The neuroimaging findings are heterogeneous, but can be grouped either anatomically (white matter, gray matter, brainstem, or leptomeninges) or pathologically (ischemic changes, hemorrhages, or cerebral edema). An understanding of the imaging manifestations of ICANS has the potential to impact the management of patients.
嵌合抗原受体T细胞（CAR-T）疗法是一种已被批准用于治疗血液系统恶性肿瘤的很有前景的免疫疗法。尽管其疗效显著，但包括免疫效应细胞相关神经毒性综合征（ICANS）在内的具有临床意义的毒性发生率限制了其广泛应用。在某些情况下，使用市售CAR-T疗法的患者中，高达三分之一可能会出现ICANS。该综合征表现为一系列神经体征和症状，以及文献中报道的各种神经影像学表现。我们对文献进行了系统综述。系统检索策略确定了24项讨论与ICANS相关的神经影像学表现的研究。影像学表现在神经毒性较高的患者中更为常见。神经影像学表现多种多样，但可按解剖学（白质、灰质、脑干或软脑膜）或病理学（缺血性改变、出血或脑水肿）进行分类。了解ICANS的影像学表现可能会影响患者的治疗管理。
