{
  "abstract": "Background/Objectives Immune effector cell-associated neurotoxicity syndrome (ICANS)-associated cognitive impairment is common in patients who receive chimeric antigen receptor T-cell (CAR-T) therapy. Hence, monitoring cognitive function is vital to guide treatment. The Clock Drawing Task (CDT) is widely employed to screen for cognitive impairment. This study evaluated the utility of the CDT in detecting ICANS in patients with haematological cancers following CAR-T therapy.Methods Data were collected from CAR-T patients at The Alfred Hospital, Melbourne, Australia. Patients underwent frequent assessments using the immune effector cell-associated encephalopathy (ICE) score and the CDT, scored using a modified CLOX (CLOX-M) rating scale, during their admission. We then retrospectively reviewed the medical records of consecutive patients who received CAR-T therapy between September 2022 and February 2024 to assess for ICANS and changes in ICE score and CDT.Results 1212 clock drawings were time-matched within an hour of an ICE score for 54 patients (39% female, 63.85 ± 13.26 years). Fourteen (26%) patients developed ICANS. CLOX-M scores significantly correlated with ICE scores ( rho=0.33, p<0.001). Mixed-effects models demonstrated a significant time by ICANS status interaction; patients who developed ICANS experienced a decrease in CLOX-M scores while patients who did not develop ICANS had relatively stable CLOX-M scores across time. Receiver Operating Characteristic (ROC) analysis demonstrated that the CLOX-M score has moderate discriminatory power (AUC=.718). A cut-off CLOX-M score of 11 had high specificity (0.997) but low sensitivity (0.139) for detecting ICANS.Conclusion The CDT can be used to complement the ICE score to improve ICANS monitoring.",
  "authors": [
    {
      "affiliations": [
        "Department of Neuroscience, Monash University, Melbourne, VIC, Australia",
        "Department of Neurology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Christina Kazzi"
    },
    {
      "affiliations": [
        "Department of Haematology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Ty Simpson"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Monash University, Melbourne, VIC, Australia",
        "Department of Neurology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Miriam Wronski"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Monash University, Melbourne, VIC, Australia",
        "Department of Neurology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Nabil Seery"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Monash University, Melbourne, VIC, Australia",
        "Department of Neurology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Robb Wesselingh"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Monash University, Melbourne, VIC, Australia",
        "Department of Neurology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Tracie H Tan"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Monash University, Melbourne, VIC, Australia",
        "Department of Neurology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Katherine Y Ko"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Monash University, Melbourne, VIC, Australia",
        "Department of Neurology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Daniel Pearce"
    },
    {
      "affiliations": [
        "Department of Haematology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Cassandra Abbott"
    },
    {
      "affiliations": [
        "Department of Haematology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Jian Li"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Monash University, Melbourne, VIC, Australia",
        "Department of Neurology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Sarah Griffith"
    },
    {
      "affiliations": [
        "Department of Haematology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Shu Min Wong"
    },
    {
      "affiliations": [
        "Department of Haematology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Shafqat Inam"
    },
    {
      "affiliations": [
        "Department of Haematology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Constantine Tam"
    },
    {
      "affiliations": [
        "Department of Haematology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Shaun Fleming"
    },
    {
      "affiliations": [
        "Department of Neurology, Alfred Health, Melbourne, VIC, Australia",
        "Department of Neuroscience, Monash University, Melbourne, VIC, Australia"
      ],
      "name": "Anneke Van der Walt"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Monash University, Melbourne, VIC, Australia",
        "Department of Neurology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Terry O’Brien"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Monash University, Melbourne, VIC, Australia",
        "Department of Neurology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Rubina Alpitsis"
    },
    {
      "affiliations": [
        "Department of Haematology, Alfred Health, Melbourne, VIC, Australia",
        "Australian Centre for Blood Diseases, Monash University, Melbourne, VIC, Australia"
      ],
      "name": "Andrew Spencer"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Monash University, Melbourne, VIC, Australia",
        "Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia",
        "School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia"
      ],
      "name": "Charles Malpas"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Monash University, Melbourne, VIC, Australia"
      ],
      "name": "Paul Sanfilippo"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Monash University, Melbourne, VIC, Australia",
        "Department of Neurology, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Mastura Monif"
    }
  ],
  "title": "3588 CLOX and neurotox: utility of clock drawing to monitor immune effector cell-associated neurotoxicity syndrome following chimeric antigen receptor T-cell therapy",
  "uid": "efbec6eb-9b35-5131-a542-064f2559d8f9"
}