Figure 4.

ICANS grading and management. Considerations and approaches for the grading and management of ICANS. The symptoms are graded according to the ASBMT consensus grading⁸³ Immune Effector Cell-Associated Encephalopathy (ICE) score, is a nonvalidated neurological scoring system to easily asses the neurological status of CAR-T cell patients (Items: orientation, naming 3 objects, following easy commands, writing, counting backwards; a maximum score of 10 points indicates no neurological impairment).⁸³ Low-dose corticosteroids: ie, 10 mg dexamethasone every 6 hours or equivalent. High-dose corticosteroids: 1000 mg methylprednisolone every 24 hours or equivalent. A concurrent CRS should be treated additionally as shown in Figure 2. Further treatment should be evaluated individually, that is, anakinra²⁶ or other experimental approaches as reported previously. ASBMT = American Society for Blood and Marrow Transplantation, CAR = chimeric antigen receptor, CRS = cytokine release syndrome, ICANS = immune effector cell-associated neurotoxicity syndrome.