A recent study published online in Blood Advances suggests that electroencephalogram (EEG) plays a crucial role in managing immune effector cell-associated neurotoxicity syndrome (ICANS) resulting from chimeric antigen receptor (CAR) T-cell therapy. Conducted by Dr. Mattéo Mauget and colleagues from the University Hospital of Rennes in France, the study evaluates the effectiveness of various diagnostic tools, including magnetic resonance imaging (MRI), lumbar puncture (LP), and EEG, in managing ICANS among real-life patients treated with CAR T-cell therapy.

The study analyzed data from 190 consecutive patients who underwent CAR T-cell therapy between August 2018 and January 2023. Of these patients, 91 (48 percent) developed ICANS during the course of treatment.

MRI was performed in 78 percent of patients diagnosed with ICANS. However, despite frequently revealing abnormal findings, therapeutic impact from MRI was observed in only 4 percent of patients. Similarly, LP was conducted in 47 percent of patients, leading to preemptive antimicrobial agent use in 7 percent of cases, with no infections detected. On the other hand, 51 patients (56 percent) underwent systematic EEG, resulting in therapeutic modifications for 16 percent of patients.

The authors of the study remark, "Our study shows that diagnostic investigations recommended by international guidelines for ICANS management rarely result in therapeutic changes for MRI (4 percent) and LP (7 percent, all irrelevant), questioning the need for systematic assessment." They highlight the importance of revising current ICANS management guidelines to limit investigations to situations with significant therapeutic impact and an optimal risk-benefit ratio.

The findings of this study underscore the critical role of EEG in managing ICANS, offering insights into refining diagnostic approaches and improving therapeutic outcomes for patients undergoing CAR T-cell therapy.