The Hidden Cognitive Toll of CAR T Therapy

CAR T-cell therapy is rightly hailed as the darling of modern oncology, having revolutionised the treatment of haematological malignancies. Yet, this 'living drug' appears to exact a neurological tariff. A comprehensive systematic review of 18 studies indicates that nearly half (44%) of recipients experience cognitive impairments, ranging from memory lapses to difficulties with executive function. For many, the relief of remission is tempered by a mental fog that simply refuses to lift.

The primary culprit is often Immune Effector Cell-Associated Neurotoxicity Syndrome, or the rather unpronounceable ICANS. This condition affects between 25% and 70% of patients, with severe cases manifesting in up to 20%. While Quality of Life generally trends upward post-treatment, those struck by severe ICANS often face a far slower recovery, battling anxiety, depression, and occasionally PTSD. Crucially, the data suggests these are not merely transient blips; for a subset of patients, cognitive deficits persist well beyond the twelve-month mark.

As we continue to harness the immune system to fight cancer, the clinical focus must widen beyond survival statistics. The review highlights the potential of EEG-based biomarkers to predict toxicity severity before it escalates. However, the immediate prescription is clear: long-term monitoring and targeted rehabilitation strategies are essential. Survival is paramount, naturally, but preserving the mind that survives is a close second.