title: Chimeric antigen receptor T-cell neuropsychiatric toxicity in acute lymphoblastic leukemia.
abstract: Chimeric antigen receptor T cells are used in the treatment of B-cell leukemias. Common chimeric antigen receptor T-cell toxicities can range from mild flu-like symptoms, such as fever and myalgia, to a more striking neuropsychiatric toxicity that can present as discrete neurological symptoms and delirium. We report here two cases of chimeric antigen receptor T-cell neuropsychiatric toxicity, one who presented as a mild delirium and aphasia that resolved without intervention, and one who presented with delirium, seizures, and respiratory insufficiency requiring intensive treatment. The current literature on the treatment and proposed mechanisms of this clinically challenging chimeric antigen receptor T-cell complication is also presented.
authors.affiliation: Department of Psychiatry and Behavioral Sciences,Memorial Sloan Kettering Cancer Center,New York,New York.
authors.forename: Vasthie
authors.initials: V
authors.lastname: Prudent
authors.affiliation: Department of Psychiatry and Behavioral Sciences,Memorial Sloan Kettering Cancer Center,New York,New York.
authors.forename: William S
authors.initials: WS
authors.lastname: Breitbart
mesh_terms: D000328:Adult; D020740:Chimerin Proteins / Q000633:toxicity*; D005260:Female; D006801:Humans; D008297:Male; D020258:Neurotoxicity Syndromes / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy*; D011948:Receptors, Antigen, T-Cell / Q000378:metabolism* / Q000627:therapeutic use
chemical_list: D020740:Chimerin Proteins; D011948:Receptors, Antigen, T-Cell
keywords: Acute lymphoblastic leukemia; Chimeric antigen receptor; Cytokine release syndrome; Neurotoxicity