CAR T-Cell Therapy: An Update for Radiologists

Abstract

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Evolution of Radiological Treatment Response Assessments for Cancer Immunotherapy: From iRECIST to Radiomics and Artificial Intelligence

“…In contrast, toxicities related to CAR-T cell therapy can be serious, as CAR-T cell therapy can cause cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), or hemophagocytic lymphohistiocytosis/macrophage activation syndrome ( Table 5 ) [ 31 32 ]. The typical time for CRS is approximately 1–5 days after infusion, with an approximate incidence of 42%–100% and severe incidence in 0%–46% of patients.…”

“…The typical time for CRS is approximately 1–5 days after infusion, with an approximate incidence of 42%–100% and severe incidence in 0%–46% of patients. ICAN usually occurs within 1–3 weeks after infusion and in 0%–50% of severe cases [ 32 33 ]. Although CRS and ICANS are usually concomitant and correlated, they rarely occur independently.…”

Response criteria for immunotherapy and the radiologic patterns of immune-related adverse events

“…The patient's T-cells are modified in vitro to express chimeric antigen receptors that can detect tumorspecific antigens. When these modified T-cells are reintroduced to the patient, they recognize the tumor cells and activate the body's immune system to attack these cells [24]. Positron emission tomography/CT (PET/CT) or Positron emission tomography/ magnetic resonance imaging (PET/MRI) is the preferred imaging modality to monitor CAR Tcell migration and response to treatment.…”

“…Brain CT and MRI are usually negative, however, they are essential to rule out other neurologic etiologies. Occasionally, brain MRI can show T2 and FLAIR hyperintensity, vasogenic edema, leptomeningeal enhancement, multifocal microhemorrhages, and cortical infarcts [24].…”

“…CT might show hepatosplenomegaly, steatosis, periportal fluid accumulation, gallbladder wall thickening, and ascites, and radiography would detect bilateral lung opacities and pleural effusions. MRI can show cerebral atrophy, white matter lesions and demyelination in the brain; and signal voids in the liver and spleen [24].…”