Alice Zhou, MD, PhD, and Omar Butt, MD, PhD, on Surprising Associations With Neurotoxicity and Neurofilament Light


The medical oncologists at Washington University School of Medicine in St. Louis discussed surprising findings from their retrospective study.

“The next stage is trying to figure out where exactly is this injury coming from. And to do that, we actually have an ongoing prospective clinical trial that's combining all that we again have learned over the years from neurodegeneration to advanced neuroimaging, neurocognitive and neuropsychological testing, as well as a range of additional markers to distill down what exactly is the type of injury at each individual time over the course of treatment. So that's the next stage of our experiment.”

The risk of developing immune effector cell–associated neurotoxicity syndrome (ICANS) is associated with plasma neurofilament light chain (NfL) levels in patients treated with chimeric antigen receptor (CAR) T-cell therapy, according to a paper published in JAMA Oncology.

Authors and medical oncologists from Washington University School of Medicine in St. Louis Omar H. Butt, MD, PhD, and Alice Y. Zhou, MD, PhD,evaluated data from 30 patients with diffuse large B-cell lymphoma treated with CAR T-cell therapy in a retrospective, 2-center study. They found that patients who developed any grade ICANS had NfL elevations (mean, 87.6 pg/mL) prior to lymphodepletion and CAR T-cell infusion compared with those who did not develop ICANS (mean, 29.4 pg/mL; P < .001).

CGTLive spoke with Butt and Zhou to learn more about the findings revealed in their study. What most surprised them is that people that developed ICANS had high NfL levels prior to treatment, in addition to concurrent with treatment.

Butt OH, Zhou AY, Caimi PF, et al. Assessment of pretreatment and posttreatment evolution of neurofilament light chain levels in patients who develop immune effector cell–associated neurotoxicity syndrome. JAMA Oncol. Published online September 01, 2022. doi:10.1001/jamaoncol.2022.3738
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