From the Assistance Publique-Hôpitaux de Paris (AP-HP) (R.U., D.M., C.B., S.C., V.V., L.S.-V., C.C., A.F.C.), Hôpital Saint-Louis, Service de Neurologie; Université de Lille (C.M.), ULR 4072-PSITEC-Psychologie: Interactions, Temps, Emotions, Cognition; Université de Paris (S.C., C.C., R.D.B., C.T., A.F.C.); and Service d' Hémato-Oncologie (R.D.B., C.T.), Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), France.
Neurology. 2022 Sep 20;99(12):511-515. doi: 10.1212/WNL.0000000000201083. Epub 2022 Jul 18.
Anti-CD19 chimeric antigen receptor (CAR) T-cell therapy is a promising treatment in relapsing B-cell lymphoma but is frequently associated with acute neurotoxicity. Neurologic long-term safety has not been thoroughly assessed.
All patients with consecutive refractory lymphoma admitted in our center for CAR T-cell therapy underwent neurologic examination, extensive neuropsychological assessment, and brain MRI (except 1 patient) and completed self-administrated questionnaires at baseline. The patients who remained disease-free at 2 years were re-evaluated similarly. All neurologic assessments were conducted by senior neurologists.
None of the 19 disease-free patients developed new neurologic deficits or MRI changes when compared with baseline. There was no difference in cognitive performances before and 2 years after, even for the 11 patients who had developed acute neurotoxicity after CAR T cells. In self-questionnaire assessments, cognitive complaint was stable, reported by 32% of the patients at 2 years. We observed a reduction in HADS anxiety scores 2 years after treatment when compared with baseline (median score: 7/21 vs 4/21, = 0.01).
In conclusion, no significant neurocognitive or neurologic disorders were observed in this cohort of patients, 2 years after treatment with anti-CD19 CAR T cells.
嵌合抗原受体（CAR）T 细胞治疗抗 CD19 对复发性 B 细胞淋巴瘤有很好的疗效，但常伴有急性神经毒性。神经长期安全性尚未得到彻底评估。
本中心连续收治的接受 CAR T 细胞治疗的复发性淋巴瘤患者均接受神经检查、广泛的神经心理学评估和脑 MRI（1 例患者除外），并在基线时完成自我管理问卷。2 年无病生存的患者进行类似的重新评估。所有神经评估均由资深神经科医生进行。
与基线相比，19 例无病生存患者均未出现新的神经缺陷或 MRI 改变。认知表现无差异，即使是在 CAR T 细胞治疗后出现急性神经毒性的 11 例患者中也是如此。在自我问卷评估中，认知主诉保持稳定，2 年后有 32%的患者报告有认知主诉。与基线相比，治疗后 2 年 HADS 焦虑评分降低（中位数评分：7/21 比 4/21， = 0.01）。
总之，在接受抗 CD19 CAR T 细胞治疗 2 年后，该队列患者未出现明显的认知或神经系统疾病。
