Evaluation of central nervous system involvement in patients undergoing chimeric antigen receptor-engineered T-cell therapy by magnetic resonance imaging

Chimeric antigen receptor-engineered (CAR) T-cell therapy is an effective immunotherapy for aggressive hematologic cancers. However, it can lead to complications such as immune effector cell-associated neurotoxicity syndrome (ICANS), or complications related to the immunosuppressive status of these patients. The role of imaging in this context is essential to help in ICANS diagnosis and to rule out other potential diagnosis, such as central nervous system infections. Two cases are presented to illustrate this clinical problem.

Case 1

describes a 38-year-old patient with diffuse large B-cell lymphoma who developed ICANS after CAR T-cell therapy. MRI revealed signs of leukoencephalopathy. Case 2 involves a 57-year-old patient with mantle-cell lymphoma who presented neurologic symptoms -clinically suggestive of ICANS- after CAR-T therapy. MRI showed signs indicative of limbic encephalitis.

These two cases highlight the importance of MRI in clinical practice after CAR T-Cell Therapy underscoring the role of MRI in the diagnosis of complications in patients with neuropsychiatric symptoms.