Kim Hyun Gi, Yeom Kristen W, Vasyliv Iryna, Shokri Varniab Zahra, Erickson Courtney, Baggott Christina, Schultz Liora Michal, Daldrup-Link Heike E
Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, Stanford, CA, USA.
Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Eur Radiol. 2025 Mar 20. doi: 10.1007/s00330-025-11515-2.
To evaluate brain MRI findings in children and young adults after chimeric antigen receptor (CAR) T-cell therapy for B-cell acute lymphoid leukemia (B-ALL) and associate results with clinical and neurological symptoms.
We reviewed pre- and post-CAR-T cell therapy brain MRIs of B-ALL patients aged 25 years or younger who underwent therapy between April 2015 and October 2023 at a single institution. MRI abnormalities were categorized as no change, exacerbation of preexisting lesion, or newly developed lesion. Clinical CAR-mediated toxicities, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) grades, were recorded. Patients were grouped into those with and without 'exacerbated/new lesion,' and clinical and neurological symptoms were compared using Fisher's exact test.
Sixteen patients with pre- and post-CAR brain MRIs (median age 16 years [interquartile range, 11-21]; 9 males, 7 females) were included in the analysis. Post-CAR brain abnormalities were observed in 81% (13/16) of patients, including white matter (WM) signal changes (12/16), leptomeningeal enhancement (1/16), and cerebellar embolic infarction (1/16). Of the post-CAR WM lesions, 50% (6/12) were exacerbated, 33% (4/12) were newly developed, and 17% (2/12) remained unchanged compared to pre-CAR brain MRI. No difference in CRS (p = 0.079) or ICANS grades (p > 0.99) was observed between patients with and without 'exacerbated/new lesions'.
Children and young adults with B-ALL can develop brain MRI abnormalities after CAR T-cell therapy, predominantly WM signal changes. These brain abnormalities did not show an association with higher CRS or ICANS grade.
Question Brain MRI findings after chimeric antigen receptor (CAR) T-cell therapy for B-cell acute lymphoid leukemia (B-ALL) and their association with clinical and neurological symptoms are not well understood. Findings Brain MRI abnormalities, mostly white matter changes, were seen in 81% of patients but were not associated with CAR-mediated toxicities. Clinical relevance Brain MRI abnormalities, commonly observed post-CAR T-cell therapy, do not correlate with the severity of CAR-related toxicities, aiding in the clinical management and monitoring of these patients.
评估嵌合抗原受体（CAR）T细胞疗法治疗B细胞急性淋巴细胞白血病（B-ALL）后儿童和青年的脑部MRI表现，并将结果与临床和神经症状相关联。
我们回顾了2015年4月至2023年10月在单一机构接受治疗的25岁及以下B-ALL患者CAR-T细胞治疗前后的脑部MRI。MRI异常分为无变化、原有病变加重或新发病变。记录临床CAR介导的毒性，包括细胞因子释放综合征（CRS）和免疫效应细胞相关神经毒性综合征（ICANS）分级。将患者分为有和无“病变加重/新发病变”两组，使用Fisher精确检验比较临床和神经症状。
分析纳入了16例有CAR治疗前后脑部MRI的患者（中位年龄16岁[四分位间距，11-21岁]；9例男性，7例女性）。81%（13/16）的患者在CAR治疗后出现脑部异常，包括白质（WM）信号改变（12/16）、软脑膜强化（1/16）和小脑栓塞性梗死（1/16）。与CAR治疗前的脑部MRI相比，CAR治疗后的WM病变中，50%（6/12）加重，33%（4/12）为新发病变，17%（2/12）无变化。有和无“病变加重/新发病变”的患者之间，CRS（p = 0.079）或ICANS分级（p > 0.99）无差异。
B-ALL儿童和青年在CAR T细胞治疗后可出现脑部MRI异常，主要为WM信号改变。这些脑部异常与较高的CRS或ICANS分级无关。
问题 嵌合抗原受体（CAR）T细胞疗法治疗B细胞急性淋巴细胞白血病（B-ALL）后的脑部MRI表现及其与临床和神经症状的关联尚不清楚。发现 81%的患者出现脑部MRI异常，主要为白质改变，但与CAR介导的毒性无关。临床意义 CAR T细胞治疗后常见的脑部MRI异常与CAR相关毒性的严重程度无关，有助于这些患者的临床管理和监测。
