Staging
Immune effector cell-associated neurotoxicity syndrome
The ASTCT consensus grades immune effector cell-associated neurotoxicity syndrome from grade 1 to grade 4 according to neurologic findings after immune effector cell therapy.
Also called: ICANS
Stages
- 1
Grade 1
ICE score 7–9; the patient awakens spontaneously.
- 2
Grade 2
ICE score 3–6; the patient awakens to voice.
- 3
Grade 3
ICE score 0–2; awakens only to tactile stimulus; a seizure that resolves rapidly or EEG seizure resolved by intervention; or focal edema on neuroimaging.
- 4
Grade 4
ICE score 0 or unarousable; life-threatening or repeated seizures without return to baseline; deep focal motor weakness; or diffuse cerebral edema.
Judged onNeurologic findings: ICE assessment, alertness, seizures, motor signs and edema
ICANS is a neurologic toxicity associated with immune effector cell therapies, including CAR T-cell therapy and T-cell-engaging treatments. It may involve altered attention or language, reduced alertness, seizures or cerebral edema. The consensus framework separates its grading from cytokine release syndrome and combines several neurologic domains, so an ICE score alone does not always determine the overall grade.