Pre-CAR-T GTE Scoring of Electroencephalogram Abnormalities as a Predictive Biomarker for ICANS

CD19-targeted chimeric antigen receptor (CAR)-T cell therapy is an effective treatment for relapsed or refractory B-cell lymphoma but is associated with adverse events such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). The pathogenesis of ICANS remains unclear, and predictive biomarkers are needed for risk stratification. This study evaluates the Grand Total EEG (GTE) score, a comprehensive scoring system for electroencephalogram (EEG) abnormalities, as a predictive biomarker for ICANS. We retrospectively analyzed 55 patients who underwent CAR-T cell therapy. ICANS occurred in 29% of patients, with CRS (grade ≥ 2) and axicabtagene ciloleucel identified as significant risk factors. Higher GTE scores correlated with ICANS severity after ICANS onset. Furthermore, the GTE score before CAR-T therapy was already significantly higher in the ICANS group (mean: 4.94 ± 3.11) than in the non-ICANS group (mean: 2.44 ± 1.71) with an odds ratio of 1.78. Patients with a history of high-dose methotrexate treatment showed elevated GTE scores, suggesting an association between CNS-targeted therapies and baseline brain dysfunction without symptoms. The findings of this study illustrate the efficacy of the GTE score as a novel biomarker for ICANS prediction. The score enables early risk stratification and directs interventions in CAR-T therapy.