Neurological complications of CAR T cell therapy for cancers
Karschnia P, Dietrich J (2025)
Publication Type: Journal article, Review article
Publication year: 2025
Journal
DOI: 10.1038/s41582-025-01112-8
Abstract
Genetically engineered chimeric antigen receptor (CAR) T cells have emerged as a powerful treatment option in patients with B cell malignancies, but neurological adverse effects are common and hamper the success of such therapies. Immune effector cell-associated neurotoxicity syndrome encompasses a wide range of acute neurological adverse effects, including encephalopathy with alterations in cognition and behaviour, language, motor function and coordination. In patients treated with CAR T cells for CNS malignancies, a more localized on-tumour, on-target neurotoxicity syndrome termed tumour inflammation-associated neurotoxicity can develop acutely, resulting in localized oedema with mass effect or in electrophysiological dysfunction with neurological symptoms. Following B cell maturation antigen-targeting CAR T cell therapies, delayed neurological complications, including cranial nerve palsies and a unique delayed-onset parkinsonism syndrome, are increasingly recognized. Management of neurological complications includes symptomatic treatments such as antiepileptic drugs or cerebrospinal fluid diversion, temporary immunosuppression with corticosteroids, various cytokine-targeting agents, and other distinct approaches depending on the nature of the toxicity. As our understanding of the mechanisms that contribute to the various neurological adverse effects of CAR T cell and other T cell-engaging therapies increases, novel treatment strategies to alleviate symptoms, as well as innovative CAR designs, promise to improve the safety and neurotoxicity of these powerful immunotherapies.
Involved external institutions
United States (USA) (US)How to cite
APA:
Karschnia, P., & Dietrich, J. (2025). Neurological complications of CAR T cell therapy for cancers. Nature Reviews Neurology. https://doi.org/10.1038/s41582-025-01112-8
MLA:
Karschnia, Philipp, and Jörg Dietrich. "Neurological complications of CAR T cell therapy for cancers." Nature Reviews Neurology (2025).
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