Progressive Multiple Cranial Neuropathies as a Manifestation of ICANS Following CAR-T

作者：Zachary Lazzari, Avi Singh Gandh, Samir Belagaje, Spencer K. Hutto · 发表于：Neurology · 年份：2024 · DOI：10.1212/01.wnl.0001051268.39803.c2 · 被引用次数：2 · 研究领域：Melanoma and MAPK Pathways、Peripheral Neuropathies and Disorders、Cancer Treatment and Pharmacology

Objective To describe a case of delayed onset multiple cranial neuropathies as manifestation of immune effector cell-associated neurotoxicity syndrome (ICANS) after chimeric antigen receptor T-cell (CAR-T) therapy for multiple myeloma. Background While ICANS following CAR-T is a well-reported complication, it classically presents with encephalopathy, headache, aphasia, tremors, seizures, and cerebral edema. Isolated unilateral facial neuropathies secondary to ICANS have been described, but multiple cranial neuropathies have not. Design/Methods N/A. Results A 75-year-old male presented with left facial nerve palsy 19 days after initiating CAR-T therapy for multiple myeloma. He developed fever, chills, and rigors 8 days post-CAR-T, which resolved with Tylenol (tocilizumab not administered). Contrasted brain MRI did not show abnormalities and his facial palsy was treated with prednisone 60 mg and Valtrex 1000 mg every 8 hours for 7 days. Left facial palsy persisted despite treatment and progressed to involve bilateral facial nerves and left cranial nerve VI by 31 days post-CAR-T. Specifically, his exam showed impaired abduction of left eye and twitches of orbicularis oculi without other facial movement (House-Brackmann grade VI bilaterally). Another contrasted MRI brain showed mild enhancement of bilateral facial nerves. Extensive serum and CSF testing was unremarkable. Initial treatment with prednisone 60 mg PO was ineffective. This was escalated to methylprednisolone 1 gram IV...