{
  "abstract": "BiTE therapy is an innovative immunotherapeutic strategy in haematological malignancies, leveraging the immune system to target and eliminate cancer cells. Whilst central neurotoxicities, such as immune effector cell-associated neurotoxicity syndrome (ICANS), are well documented, peripheral immune-mediated complications remain under-recognised.Recent literature describes neurological toxicities beyond ICANS, including transverse myelitis, Guillain-Barré syndrome (GBS), acute disseminated encephalomyelitis (ADEM), and cranial neuropathies. These are presumed to be immune-mediated, though the underlying mechanisms remain unclear. Notably, they can occur independently of cytokine release syndrome (CRS) and have been associated with T-cell-rich infiltrates on nerve biopsy, suggesting direct immune-mediated inflammation.We present an 83-year-old female who had a progressive sensorimotor syndrome of all 4 limbs over a few days, with then, acute, painless, focal weakness of her left foot. She was 4 weeks post commencement of Epcoritamab (a BiTE therapy) with good treatment response to date. Examination was concordant with an asymmetric peripheral nervous system disorder, without features of ICANS. Nerve conduction studies revealed a sural-sparing, asymmetric, demyelinating and axonal sensorimotor neuropathy with multifocal conduction block. MRI demonstrated smooth cauda equina enhancement without nodular features or lymphomatous deposits. Extensive CSF testing was normal. Treatment with Methylprednisolone and Anakinra led to rapid clinical recovery.This case highlights the emerging risk of peripheral immune-mediated neuropathies following BiTE therapy. As its use expands, early recognition and intervention are crucial to mitigate morbidity.",
  "authors": [
    {
      "affiliations": [
        "Neurology, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia"
      ],
      "name": "John Girgis"
    },
    {
      "affiliations": [
        "Neurology, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia",
        "Griffith University, QLD, Australia"
      ],
      "name": "Antony Winkel"
    },
    {
      "affiliations": [
        "Neurology, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia",
        "Griffith University, QLD, Australia"
      ],
      "name": "Andrew Clarke"
    }
  ],
  "title": "3687 Acute, asymmetric, inflammatory neuropathy following bispecific T-cell engager (BiTE) therapy: an emerging immune-mediated complication",
  "uid": "18c91375-ddfe-5aa8-8a7e-c3cdc5f03c53"
}