EEG features and synek scale indicate severity of neurotoxicity in adult patients treated with CD19 CAR T-cell therapy Journal Article

   

Authors:	Mao, D.; Reiner, A. S.; Chen, X.; Park, J.; Pennisi, M.; Perales, M. A.; Avila, E. K.; Santomasso, B. D.
Article Title:	EEG features and synek scale indicate severity of neurotoxicity in adult patients treated with CD19 CAR T-cell therapy
Abstract:	Patients who develop chimeric antigen receptor (CAR) T-cell-related immune effector cell-associated neurotoxicity syndrome (ICANS) frequently undergo evaluation with electroencephalography (EEG). We hypothesize that EEG features and Synek scale score, a measure of degree of EEG abnormality, are associated with ICANS severity. Here, we performed a retrospective review of 125 adult patients at Memorial Sloan Kettering Cancer Center (MSKCC) who received CAR-T cell therapy from 2010 to 2019, including 53 patients with B-acute lymphoblastic leukemia treated with 1928z CAR T cells (NCT01044069) and 72 patients with large B-cell lymphoma (LBCL) treated with the commercial CAR T products axicabtagene ciloleucel or tisagenlecleucel. We collected video EEG monitoring (27 with B-ALL and 20 with LBCL) and recorded daily EEG features, Synek scores, and ICANS grade for 47 eligible patients. Synek scale and ICANS grade were positively correlated (correlation coefficient 0.47, 95% CI: 0.31–0.60). This was further corroborated in the univariable model associating high Synek scale (3 or 4) with high ICANS grade (OR = 15.2; 95%CI:7.8–29.7, p < 0.0001). EEG features such as discontinuity, absence of posterior dominant rhythm, and presence of generalized sharp waves were statistically significantly associated with higher ICANS grade in univariable models. In the multivariable model, discontinuity (OR = 4.2 (95%CI:1.3–13.8, p = 0.02) and absence of posterior dominant rhythm (OR = 10.5 (95%CI:4.6–23.9, p < 0.0001) were statistically associated with higher ICANS grade. Overall, EEG discontinuity and absence of posterior dominant rhythm were independently associated with higher severity of neurotoxicity. Further, our data suggest that Synek Scale, may be a severity marker for neurotoxicity. © The Author(s) 2024.
Keywords:	eeg; immune-related adverse events; car t-cell therapy; icans; synek
Journal Title:	Scientific Reports
Volume:	14
ISSN:	2045-2322
Publisher:	Nature Publishing Group
Date Published:	2024-11-23
Start Page:	29090
Language:	English
DOI:	10.1038/s41598-024-80566-0
PROVIDER:	scopus
PMCID:	PMC11585625
PUBMED:	39580601
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85209950790&doi=10.1038%2fs41598-024-80566-0&partnerID=40&md5=59c703bdae6d6367362dd391a9a8575e
Notes:	Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/220617