Neural Noise

EEG as predictor of neurotoxicity and outcomes in CAR T-cell therapy

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  • EEG is evaluated as an electrophysiological biomarker for neurotoxicity and clinical outcomes related to chimeric antigen receptor (CAR) T-cell therapy.1
  • Clinical Neurophysiology (Volume 183) addresses the utility of EEG in predicting CAR T-cell therapy–related neurotoxicity and outcomes.1 1

Weekly enrichment (2026-07-20)

  • The primary study is a retrospective multicenter analysis across Mayo Clinic Florida, Minnesota, and Arizona of adults who received CAR T-cell therapy between October 2019 and July 2024, enrolling 207 patients (111 female); pre-treatment EEG was performed in 50.2% of them.2
  • In multivariable analysis of EEG, imaging, and clinical data, generalized slowing on pre-treatment EEG (p = 0.021) and older age (roughly 1% increased odds per year, p = 0.006) were associated with immune effector cell-associated neurotoxicity syndrome (ICANS).2
  • Patients who developed ICANS had significantly longer hospitalization (p < 0.001) and were less likely to survive at 12 and 24 months (p = 0.001 and p < 0.001), though no factors independently predicted hospital duration or survival within the ICANS group.2
  • The article was published in Clinical Neurophysiology (Volume 183, article 2111484; DOI 10.1016/j.clinph.2025.2111484; PMID 41494410), concluding that pre-treatment EEG plus age may help flag patients at risk of ICANS.2
  • Context: an independent anti-CD19 CAR T-cell cohort reported that post-infusion EEG changes consistent with encephalopathy can emerge presymptomatically and anticipate clinical ICANS onset by a median of about 4 days, enabling earlier intervention.3
  • Context: an Italian anti-CD19 cohort found focal synchronous bilateral slow EEG activity to be an independent ICANS predictor (odds ratio 9.34, p = 0.016); of 10 patients with both baseline diffuse cerebral slowing and elevated gamma-GT (>45), 9 developed ICANS (OR 9, 95% CI 1.14–71.03), with several developing nonconvulsive status epilepticus treated with levetiracetam.4
  • Quantitative/qualitative EEG grading scales (e.g., VE-ICANS) correlate with clinical ICANS grade (Pearson R = 0.59) and discriminate ICANS ≥ 2 with an AUC of 0.91; slowing below 8 Hz—and especially below 3 Hz—was the most predictive EEG feature.5
  • Background: ICANS occurs in roughly 20–60% of CAR T-cell recipients, with severe (≥ grade 3) disease in about 12–30%; it is diagnosed clinically via the 10-point Immune Effector Cell Encephalopathy (ICE) score, and EEG can be normal or show slowing and nonconvulsive status epilepticus.6

Footnotes

  1. https://www.sciencedirect.com/science/article/pii/S1388245725013367?dgcid=rss_sd_all ↩ ↩2 ↩3

  2. https://doi.org/10.1016/j.clinph.2025.2111484 ↩ ↩2 ↩3 ↩4

  3. https://pmc.ncbi.nlm.nih.gov/articles/PMC12031834/ ↩

  4. https://doi.org/10.1002/brb3.70891 ↩

  5. https://doi.org/10.1038/s41598-022-24010-1 ↩

  6. https://www.ncbi.nlm.nih.gov/books/NBK584157/ ↩

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