Complexity of baseline cognitive and psychological status in haematology patients planned for chimeric antigen receptor T-cell therapy

BackgroundImmune effector cell-associated neurotoxicity syndrome (ICANS) is a relatively common consequence of chimeric antigen receptor T-cell (CAR-T) therapy, with a wide range of possible cognitive presentations. The aim of this study was to characterise a real-word cognitive and psychological status of patients with advanced haematologic and solid organ malignancies planned for CAR-T. We also aimed to examine utility of two cognitive screening approaches. MethodsPatients underwent specialist cognitive assessment, including a self-report questionnaire of psychopathology and subjective cognitive function. A subset of individuals also completed the Montreal Cognitive Assessment (MoCA). ResultsOf 60 patients included, 15-16 (25%-27%) presented with evidence of cognitive impairment, with six unique patterns of dysfunction. Impaired patients were more likely to have B-cell acute lymphoblastic leukaemia (BF10=9.30), be younger (BF10=7.76), have bone marrow involvement (BF10=5.18), report history of anxiety (BF10=4.85), or have evidence of psychopathology (BF10=31.30). Analyses did not support the utility of cognitive screening. Of those patients who completed a self-report measure of psychopathology, nine (15.8%) were elevated on at least one symptom domain. ConclusionsThe findings demonstrate a broad spectrum of dysfunction and psychopathology in this cohort, emphasising the importance of baseline evaluation for detecting cognitive neurotoxicity symptoms that might arise after CAR-T infusion.