{
  "abstract": "Chimeric antigen receptor (CAR)-T cell therapies have transformed the management of relapsed or refractory haematological malignancies and are now being adapted for severe B-cell mediated autoimmune disease, including neuroimmunological disorders. Their appeal lies in deep and durable B-cell depletion within lymphoid tissues and target organs, with the potential to induce long-lasting, treatment-free remission. At the same time, broader application is constrained by serious toxicities, in particular, neurological complications such as immune effector cell-associated neurotoxicity syndrome (ICANS) and more recently recognised movement, cerebellar, cranial nerve and peripheral nerve syndromes. In this review, we outline the biological principles of CAR-T cell therapy and summarise the emerging experience in neuroimmunology. We draw on data from both oncology and early autoimmune trials to describe the clinical spectrum, timing and proposed mechanisms of CAR-T cell-related neurotoxicity and to distinguish ICANS from later and more focal toxicities. As CAR-T cell therapies move from cancer centres into the care of patients with refractory neuroimmunological disease, neurologists will need a detailed understanding of both their therapeutic promise and their neurological risks, and close collaboration within multidisciplinary teams will be essential to deliver these treatments safely.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, Austin Health, Heidelberg, Victoria, Australia",
        "Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"
      ],
      "name": "Daniel G Raffoul"
    },
    {
      "affiliations": [
        "Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia",
        "CORe, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Izanne Roos"
    },
    {
      "affiliations": [
        "Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia",
        "Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia"
      ],
      "name": "Matthias Mulazzani"
    },
    {
      "affiliations": [
        "Department of Clinical Haematology, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia"
      ],
      "name": "Mary Ann Anderson"
    },
    {
      "affiliations": [
        "Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia",
        "Department of MS and Neuroimmunology, Alfred Health, Melbourne, Victoria, Australia",
        "Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"
      ],
      "name": "Mastura Monif"
    },
    {
      "affiliations": [
        "Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia",
        "Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Justin Garber"
    },
    {
      "affiliations": [
        "Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Anneke van der Walt"
    },
    {
      "affiliations": [
        "Department of Neurology, St Vincent’s Hospital Sydney, Sydney, New South Wales, Australia",
        "School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "Jennifer Massey"
    },
    {
      "affiliations": [
        "Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia",
        "CORe, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia",
        "Department of Clinical Haematology, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia"
      ],
      "name": "Valeriya Kuznetsova"
    },
    {
      "affiliations": [
        "Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia",
        "Department of MS and Neuroimmunology, Alfred Health, Melbourne, Victoria, Australia",
        "Department of Neurology, University Hospital, Geelong, Geelong, Victoria, Australia"
      ],
      "name": "Cassie Nesbitt"
    },
    {
      "affiliations": [
        "Department of Clinical Haematology, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia",
        "Centre of Excellence in Cellular Immunotherapy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia",
        "Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Mark Dowling"
    },
    {
      "affiliations": [
        "Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia",
        "Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Irene Ruderman"
    },
    {
      "affiliations": [
        "Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia",
        "Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia",
        "Department of Radiology, University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Arian Lasocki"
    },
    {
      "affiliations": [
        "Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia",
        "Central Clinical School, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Constantine S Tam"
    },
    {
      "affiliations": [
        "Department of Clinical Haematology, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia",
        "Centre of Excellence in Cellular Immunotherapy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia",
        "Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Simon J Harrison"
    },
    {
      "affiliations": [
        "Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia",
        "CORe, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Tomas Kalincik"
    }
  ],
  "title": "Neurological implications of chimeric antigen receptor-T cell therapy",
  "uid": "29878425-680e-5fca-9356-c917da3bff70"
}