Work

Development of a Modified Immune Effector Cell-Associated Encephalopathy Score for the Developmentally Delayed Patient

Year: 2025

Type: article

Abstract: Topic Significance & Study Purpose/Background/Rationale Cellular therapies have grown exponentially since 2017 when the first Chimeric Antigen Receptor T-Cell (CAR-T) therapy was FDA approved, however, immune effector cell-associated neurotoxicity syndrome (ICANS) remains a serious risk of treatment, necessitating routine neurological assessments. The standard tool for these assessments is the Immune Effector Cell-Associated Encephalopathy (ICE) scoring system , a 10-point scale evaluating orientation and cognition through tasks such as counting backwards, writing a standard sentence, following commands, and naming objects. As the use of cellular therapies increases, a key concern arises: how can we administer these therapies to patients with developmental delays who cannot complete the ICE score at baseline? Methods, Intervention, & Analysis To address this issue, several major cancer institutions, including pediatric centers , were surveyed. It became clear that no assessment tool existed for developmentally delayed patients. Consequently, a decision was made for an interdisciplinary team to create a tool for an upcoming patient in need of cellular therapy, with the intention of using it for future patients. This modified ICE-score also employs a 10-point scale and evaluates the patient's ability to identify time of day and location through image selection, following commands, writing their name, and assesses for underactivity, restlessness, and inconsolability (Figure 1). It was successfully implemented for a nonverbal adult with developmental delays receiving CAR-T treatment for acute lymphoblastic leukemia . Findings & Interpretation This tool was used at baseline with the patient, resulting in a 10/10 score. After the baseline assessment demonstrated success, this tool was used throughout her CAR-T treatment course (day 0 until discharge). The timing of the use of this tool and our subsequent responses to its scores followed our institution's standard of care . This tool proved to be sufficient in monitoring for ICANS throughout cellular therapy treatment for this patient. Discussion & Implications The successful application of this tool for a developmentally delayed patient demonstrates its potential for future patients with similar challenges. However, its validity must be confirmed with a larger patient population. Next steps involve expanding its application to more patients to establish validity, enabling us to broaden use and provide essential medical care, including cellular therapies, to those with developmental delays in need of treatment.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.jtct.2025.01.699

Authors: Karley Stark, Jordan Leal, Liza Rodriguez, Zahra Mahmoudjafari, Anurag K. Singh

Institutions: The University of Kansas Health System, University of Kansas, The University of Kansas Cancer Center, University of Kansas Medical Center

Language: English

Topic: CAR-T cell therapy research

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,650