The use of intrathecal chemotherapy and dexamethasone for secondary prevention of blinatumomab-related neurotoxicity

Management of adults and children receiving CAR T-cell therapy: 2021 best practice recommendations of the European Society for Blood and Marrow Transplantation (EBMT) and the Joint Accreditation Committee of ISCT and EBMT (JACIE) and the European Haematology Association (EHA)

“…In refractory CRS/MAS, chemotherapy can be used, although there is a lack of data and a high risk of ablating the CAR-T. Where there is neurological involvement, intrathecal chemotherapy can be considered. 39,40 Immune effector cell-associated neurotoxicity syndrome (ICANS) ICANS affects 20%-60% of CD19 CAR-Tpatients (grade !3, 12%-30%). Onset is typically 3-5 days after CAR-T but can occur concurrently with/shortly after CRS, and 10% of patients develop 'delayed ICANS' >3 weeks after the infusion.…”

Timing of intrathecal chemotherapy and blinatumomab impacts neurotoxicity in acute lymphoblastic leukemia

“…[5][6] Interestingly, a case report describing secondary prophylaxis with IT chemotherapy in a patient receiving blinatumomab has also been described and a prospective clinical trial to evaluate this utility is underway (NCT 05519579). [7][8] This may also explain why Ngo, et al saw a neuroprotective effect when IT chemotherapy was administered later in blinatumomab treatment, as compared with an increase in neurotoxicity when administered upfront or early during blinatumomab infusion. In these cases, systemic inflammation and circulating cytokines induced by blinatumomab therapy may have already been present and susceptible to the cytotoxic effects of IT chemotherapy.…”