• Amanda M Rivera, Scott May, Matthew Lei, Stephanie Qualls, Katelyn Bushey, Daniel B Rubin, and Megan E Barra.
• Departments of Pharmacy (Drs Rivera, Lei, and Barra) and Neurology (Mss Qualls and Bushey and Dr Rubin), Massachusetts General Hospital, Boston; and Department of Pharmacy, Connecticut Children's Hospital, Hartford (Dr May).
• Crit Care Nurs Q. 2020 Apr 1; 43 (2): 191-204.

AbstractAxicabtagene ciloleucel and tisagenlecleucel are 2 chimeric antigen receptor (CAR) T-cell immunotherapies targeting CD19 for the treatment of B-cell acute lymphoblastic leukemia and non-Hodgkin lymphoma. Two commonly recognized complications associated with CAR T-cell therapies are cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). ICANS can occur in isolation or concomitantly with CRS following CAR T-cell therapy and may be due to disruption of the blood-brain barrier and the effects of elevated cytokine levels on the central nervous system. Presently, the optimum management of ICANS remains elusive, as there lacks consensus guidelines. The objective of this review is to provide a comprehensive summary of ICANS and strategies for prompt identification and management of patients presenting to the intensive care unit with this syndrome.

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