Association of neurofilament light chain levels with development of ICANS in patients receiving CAR T-cell therapy

After chimeric antigen receptor (CAR) T-cell therapy, 40% to 60% of patients will develop immune effector cell-associated neurotoxicity syndrome (ICANS). Grade 3 or higher ICANS can cause substantial morbidity and mortality. Early identifcation of patients at risk for ICANS is critical for preemptive management. A cross-sectional study at two US centers found that plasma levels of neurofilament light chain (Nfl) before infusion were elevated in patients who developed ICANS, and remained elevated for at least 30 days after infusion. The authors conclude that preinfusion Nfl levels suggest ICANS may unmask preexisting neurologic injury, suggesting that early screening is feasible before CAR T-cell therapy.