# Intravenous Immunoglobulin (IVIG) for Patients with Severe Neurotoxicity Associated with Chimeric Antigen Receptor T-Cell (CAR-T) Therapy

## TL;DR

This study explores the use of IVIG as a treatment for severe neurotoxicity in patients undergoing CAR-T therapy for lymphoma.

## Contribution

The study provides insights into the safety and potential efficacy of IVIG in managing severe ICANS in CAR-T-treated patients.

## Key findings

- IVIG was found to be tolerable and safe in patients with severe ICANS.
- Patients receiving IVIG had more severe ICANS grades at baseline.
- There was no significant difference in time to resolution of ICANS between IVIG and glucocorticoids-only groups.

## Abstract

Severe immune effector cell-associated neurotoxicity syndrome (ICANS) occurs in about 30% of all patients with large B-cell lymphoma (LBCL) who are treated with axicabtagene ciloleucel (axi-cel). There are currently limited treatment strategies other than the standard corticosteroids, and it is essential to find additional therapies to manage severe ICANS. We conducted a retrospective study of neurologic outcomes among patients who received axi-cel for LBCL from May 2015 to February 2019. We identified patients who developed severe ICANS and were treated with glucocorticoids followed by intravenous immunoglobulin (IVIG) (n  =  9) or glucocorticoids alone (n  =  10). There was no statistically significant difference in the time to resolution (TTR) of severe ICANS between groups; however, patients in the IVIG had more severe grades of ICANS with a lower performance status at baseline. The cumulative steroid days were 11.2 in the IVIG arm and 13.5 in the glucocorticoids-only arm. The use of IVIG for severe ICANS after axi-cel therapy was tolerable and safe and is generally recommended in the CAR-T setting in patients with hypogammaglobinemia. The use of IVIG as a potential therapeutic agent for severe ICANS can be further explored in future prospective studies.