Table 2.

Neurologic testing in the management of CAR T-cell therapy toxicities

	Before CAR T-cell therapy	From 1 to 30 d after CAR T-cell therapy	1 mo after CAR–T-cell therapy
Neurological assessment	YES, baseline mental status, neuro history (Nervous system toxicity from prior therapy, seizure, stroke, migraine, CNS disease, radiation, trauma, andneuropathy).	YES, monitor ICANS, additional attention to handwriting, movement, and personality changes for BCMA-CAR T-cell therapy. High-prolonged CRS increases the risk of ICANS.	YES, full assessment at 1-3-6 months may be indicated in the case of delayed or prolonged neurotoxicity or in the case of BCMA products to screen for early signs of movement and MNTs.
EEG	Generally, not helpful unless a history of epilepsy.	YES, during ICANS to r/o nonconvulsive seizures and to monitor critically ill patients.	YES, consider if any recurrent altered mental status.
Neuroimaging	YES, if history of CNS disease in cases of preexisting neurologic injury.	YES, if ICANS occurs.	YES, for any delayed neurologic symptoms.
CAR T measurements (blood and CSF)	N/A	Unclear utility in the short-term management.	May be helpful if available. High levels of CAR T cells in blood have been associated with recurrent symptoms/delayed neurotoxicity. The role of CSF CAR measurement is unclear.
LP for CSF evaluation	YES, strongly consider if history of CNS disease.	May be diagnostic and therapeutic during ICANS.	May be diagnostic and therapeutic to rule out alternative etiologies in case of new neurologic symptoms.

N/A, not available; r/o, rule out.