Abstract Details

Title Acute Symptomatic Seizures During CAR T-Cell Therapy for Hematologic Malignancies: Tri-Site Mayo Clinic Experience

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S20 - Epilepsy Clinical Outcomes and Prognostication (3:54 PM-4:06 PM)

Poster/Presentation
Number 003

Background Chimeric antigen receptor T-cell (CAR T-cell) therapy is associated with neurotoxicity, which may include acute symptomatic seizures (ASyS). The specific risk factors and short and long term outcomes of ASyS associated with CAR T-cell therapy have not been well investigated.

Objective To evaluate the incidence and risk factors for ASyS during CAR T-cell therapy.

Design/Methods This retrospective study was approved by the institutional review board at Mayo Clinic Florida. We included adult patients receiving CAR-T cell therapy across all 3 Mayo sites between October 2019 and November 2023.

Results We included 180 patients with 8 (4.4%) developing ASyS at a mean of 8.0 +/- 5.3 days after therapy. Earlier onset of cytotoxic release syndrome, higher grade immune effector cell-associated neurotoxicity syndrome (ICANS), focal neurological deficits, and cefepime exposure were significantly associated with a higher risk of ASyS. A multivariate model accounting for age and gender fit best using the lowest minimum immune effector cell encephalopathy (ICE) score and highest ICANS grade. ASyS was associated with death at last follow up though this may be confounded by more severe critical illness, and short term outcomes were not affected by ASyS. Antiseizure medication (ASM) prophylaxis did not affect ASyS incidence.

Conclusions This study suggests a low risk of ASyS due to CAR T-cell therapy, with certain risk factors that may predict ASyS listed above, and lack of a definitive and direct association of ASyS with outcomes in this population. The current approach to ASM prophylaxis should be reconsidered, and ASM prophylaxis should be used conservatively in patients undergoing CAR T-cell therapy.

Authors/Disclosures
Brin Freund, MD PRESENTER	Dr. Freund has received research support from Mayo Clinic.
Andy Shar	Mr. Shar has nothing to disclose.
Toni Betiku	Miss Betiku has nothing to disclose.
Anteneh M. Feyissa, MD, MSc, FAAN (Mayo Clinic)	Dr. Feyissa has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurelis.
Cornelia Drees, MD (Mayo Clinic Arizona)	Dr. Drees has nothing to disclose.
Wendy Sherman, MD (Mayo Clinic)	Dr. Sherman has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Focused ultrasound foundation . Dr. Sherman has received personal compensation in the range of $500-$4,999 for serving as a Advisory Board Member with Kiyatec.
Hong Qin, MD, PhD	Dr. Qin has received personal compensation for serving as an employee of Mayo Clinic Florida. The institution of Dr. Qin has received research support from NIH R01 grant. Dr. Qin has received intellectual property interests from a discovery or technology relating to health care.
Jeffrey W. Britton, MD, FAAN (Mayo Graduate School of Medicine)	Dr. Britton has received personal compensation in the range of $0-$499 for serving as a Online course with American Clinical Neurophysiology Society.
Maria S. Barrios, MD (MAYO CLINIC FLORIDA)	Dr. Barrios has nothing to disclose.
Alfredo Quinones-Hinojosa	Alfredo Quinones-Hinojosa has nothing to disclose.
William O. Tatum IV, DO, FAAN (Mayo Clinic)	Dr. Tatum has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bioserenity. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Natus. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurelis. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Defense Law Firm on behalf of a patient with epilepsy with funds donated to the Epilepsy Foundation of America. The institution of Dr. Tatum has received research support from Esai. The institution of Dr. Tatum has received research support from Mayo Clinic. The institution of Dr. Tatum has received research support from Liva Nova. The institution of Dr. Tatum has received research support from Engage Pharmaceuticals. The institution of Dr. Tatum has received research support from Xenon. Dr. Tatum has received intellectual property interests from a discovery or technology relating to health care. Dr. Tatum has received publishing royalties from a publication relating to health care. Dr. Tatum has received publishing royalties from a publication relating to health care. Dr. Tatum has received publishing royalties from a publication relating to health care. Dr. Tatum has a non-compensated relationship as a AAN Section Chair of Clinical Neurophysiology with AAN that is relevant to AAN interests or activities.

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