Evaluation of central nervous system involvement in patients undergoing chimeric antigen receptor-engineered T-cell therapy by magnetic resonance imaging

Abstract

Chimeric antigen receptor-engineered (CAR) T-cell therapy is an effective immunotherapy for aggressive hematologic cancers. However, it can lead to complications such as immune effector cell-associated neurotoxicity syndrome (ICANS), or complications related to the immunosuppressive status of these patients. The role of imaging in this context is essential to help in ICANS diagnosis and to rule out other potential diagnosis, such as central nervous system infections. Two cases are presented to illustrate this clinical problem.

Case 1

describes a 38-year-old patient with diffuse large B-cell lymphoma who developed ICANS after CAR T-cell therapy. MRI revealed signs of leukoencephalopathy. Case 2 involves a 57-year-old patient with mantle-cell lymphoma who presented neurologic symptoms -clinically suggestive of ICANS- after CAR-T therapy. MRI showed signs indicative of limbic encephalitis.

These two cases highlight the importance of MRI in clinical practice after CAR T-Cell Therapy underscoring the role of MRI in the diagnosis of complications in patients with neuropsychiatric symptoms.

Resumen

La inmunoterapia de células T con Receptores Quiméricos de Antígenos (Chimeric Antigen Receptor-engineered T-cell, CAR-T) es efectiva en algunas neoplasias hematológicas, pero conlleva riesgos como el síndrome de neurotoxicidad asociado a células efectoras inmunitarias (Immune effector cell-associated neurotoxicity síndrome, ICANS), y otras complicaciones debido a la inmunosupresión. La resonancia magnética (RM) puede ayudar en el diagnóstico de ICANS y descartar otros diagnósticos como infecciones del sistema nervioso central. Se presentan dos casos para ilustrarlo.

Caso 1

paciente de 38 años con linfoma B difuso de células grandes que desarrolló ICANS posterapia CAR-T. La RM reveló signos de leucoencefalopatía. Caso 2: paciente de 57 años con linfoma de células del manto con síntomas neurológicos sugestivos de ICANS posterapia CAR-T. La RM mostró anomalías en el hipocampo lo que indica encefalitis límbica.

Estos casos resaltan la importancia de la RM después de la terapia con CAR-T y subrayan su papel en el diagnóstico de complicaciones en pacientes con síntomas neuropsiquiátricos.