Table 2. American Society for Transplantation and Cellular Therapy (ASTCT) Immune Effector Cell–Associated Neurotoxicity Syndrome (ICANS) Consensus Grading for Adults.
| Clinical event | Grade 1 | Grade 2 | Grade 3 | Grade 4 |
|---|---|---|---|---|
| ICEa score | 7–9 | 3–6 | 0–2 | 0 (unable to score secondary to patient inability to communicate) |
| Depressed level of consciousness | Awakens spontaneously | Awakens to voice | Awakens only to tactile stimulus | Patient is unarousable or requires vigorous or repetitive tactile stimuli to arouse; stupor or coma |
| Seizure | None | None | Any clinical seizure (focal or generalized) that resolves rapidly or nonconvulsive seizures on EEG that resolve with intervention | Life-threatening prolonged seizure (> 5 min) or repetitive clinical or electrical seizures without return to baseline in between |
| Cerebral edema, elevated intracranial pressure | None | None | Focal/local edema on neuroimaging | Diffuse cerebral edema on neuroimaging; decerebrate or decorticate posturing; or cranial nerve VI palsy; or papilledema; or Cushing’s triad |
| Motor findings | None | None | None | Deep focal motor weakness such as hemiparesis or paraparesis |
Note. EEG = electroencephalogram. Information from Lee et al. (2019).
aSee Table 3 for ICE score.