What is neurotoxicity?

Neurotoxicity is a term used when a treatment causes problems with the nervous system, including the brain, spine, or nerves. In cancer care, some therapies can affect how brain cells communicate or may cause inflammation in the brain. 

What is ICANS?

ICANS stands for immune effector cell-associated neurotoxicity syndrome. It is a type of neurotoxicity that can happen after CAR T-cell therapy. ICANS occurs when active immune cells cross into the brain and cause inflammation and damage.

This side effect is common in people with myeloma who receive CAR-T. Most people who get ICANS experience it about 5 to 10 days after their treatment, but it can happen later, too. ICANS symptoms can often be treated, and many people recover over time. 

If you are a patient or care partner, it is important to be aware of ICANS symptoms to catch them early so doctors can help manage them quickly. Let your healthcare team know right away if you notice anything unusual.

How is ICANS graded and treated?

Doctors grade ICANS from 1 to 4, depending on how severe the symptoms are. Each level has different symptoms and treatments. 

Grade 1 – Mild

• Confusion
• Very tired
• The person wakes up from sleep on their own

Treatment may include:

• Supportive care (rest, fluids)
• IV hydration
• A brain check-up (neurology exam)
• Brain scans like EEG or MRI
• Anti-seizure medicine if needed

Grade 2 – Moderate

• Delirium (confused thinking)
• Drowsy and wakes from sleep to voices

Treatment may include:

• Same care as in Grade 1
• Possible move to intensive care unit (ICU)
• Anti-seizure medicine
• Low-dose corticosteroids to reduce inflammation

Grade 3 – Severe

• Seizures that go away with treatment
• Swelling from fluid buildup in the brain
• Only wakes from sleep to touch

Treatment may include:

• Same care as in Grade 2
• ICU care
• Ongoing corticosteroids
• Continuous anti-seizure medicine
• More brain scans to monitor

Grade 4 – Life-threatening

• Coma
• Serious seizures lasting longer than 5 minutes
• Brain swelling
• Muscle weakness
• Cannot be woken from sleep or is very difficult to wake

Treatment may include:

• Same care as in Grade 3
• High-dose corticosteroids
• Special treatments for severe brain swelling or long seizures
• Personalized care based on the symptoms

Key takeaways

ICANS is a possible side effect of CAR T-cell therapy for myeloma. It can range from mild confusion to more serious brain issues. Knowing the signs and reporting them early helps doctors treat the condition before it worsens. Most people improve with proper care.