Kuznetsova Valeriya, Oza Harsh, Rosenfeld Hannah, Sales Carmela, van der Linde Samantha, Roos Izanne, Roberts Stefanie, D'Aprano Fiore, Loi Samantha M, Dowling Mark, Dickinson Michael, Kalincik Tomas, Harrison Simon J, Anderson Mary Ann, Malpas Charles B
Centre of Excellence for Cellular Immunotherapy and Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
BMJ Neurol Open. 2024 Aug 22;6(2):e000800. doi: 10.1136/bmjno-2024-000800. eCollection 2024.
INTRODUCTION: Immune effector cell-associated neurotoxicity syndrome (ICANS) is a common side-effect of chimeric antigen receptor T-cell (CAR-T) therapy, with symptoms ranging from mild to occasionally life-threatening. The neurological, cognitive, psychiatric and psychosocial sequelae of ICANS are diverse and not well defined, posing a challenge for diagnosis and management. The recovery trajectory of the syndrome is uncertain. Patients are rarely examined in this population pretherapy, adding a layer of complexity to specifying symptoms pertinent solely to CAR-T treatment. We present a protocol of a prospective longitudinal research study of adult patients in a single Australian haematology service undergoing CAR-T therapy. The study will describe neurocognitive features specific to ICANS, characterise the underlying syndrome, capture recovery, identify predictors of differential postinfusion outcomes and determine a set of cognitive instruments necessary to monitor patients acutely. METHODS AND ANALYSIS: This is a prospective longitudinal study that comprises neuropsychological and neurological examinations occurring prior to CAR-T, during the acute post-treatment period, 28 days, 6 months and 12 months post infusion. Data will be sourced from objective psychometric measures, clinical examinations, self-report questionnaires of psychopathology and accounts of subjective cognitive complaint. ETHICS AND DISSEMINATION: This study aims to guide diagnosis, management and monitoring of neurocognitive features of CAR-T cell therapy. Results of this study will be disseminated through publication in peer-reviewed journals and presentations at scientific conferences. All procedures involving human subjects/patients were approved by the Peter MacCallum Cancer Centre Human Research Ethics Committee (21/145).
引言:免疫效应细胞相关神经毒性综合征(ICANS)是嵌合抗原受体T细胞(CAR-T)疗法的常见副作用,症状从轻到重,偶尔会危及生命。ICANS的神经、认知、精神和心理社会后遗症多种多样且定义不明确,给诊断和管理带来了挑战。该综合征的恢复轨迹尚不确定。在这一人群中,治疗前很少对患者进行检查,这增加了明确仅与CAR-T治疗相关症状的复杂性。我们提出了一项针对澳大利亚一家血液学服务机构中接受CAR-T治疗的成年患者的前瞻性纵向研究方案。该研究将描述ICANS特有的神经认知特征,表征潜在综合征,记录恢复情况,确定输注后不同结果的预测因素,并确定急性监测患者所需的一套认知工具。 方法与分析:这是一项前瞻性纵向研究,包括在CAR-T治疗前、治疗后急性期、输注后28天、6个月和12个月进行神经心理学和神经学检查。数据将来自客观心理测量、临床检查、精神病理学自我报告问卷以及主观认知主诉记录。 伦理与传播:本研究旨在指导CAR-T细胞疗法神经认知特征的诊断、管理和监测。本研究结果将通过在同行评审期刊上发表以及在科学会议上进行展示来传播。所有涉及人类受试者/患者的程序均获得彼得·麦卡勒姆癌症中心人类研究伦理委员会(21/145)的批准。
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