Table 4.

ASTCT Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) Consensus Grading for Adults

Neurotoxicity Domain	Grade 1	Grade 2	Grade 3	Grade 4
ICE score*/**	7–9	3–6	0–2	0 (patient is unarousable and unable to perform ICE)
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	N/A	N/A	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
Motor findings‡	N/A	N/A	N/A	Deep focal motor weakness such as hemiparesis or paraparesis
Elevated ICP/ Cerebral edema	N/A	N/A	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

Notes: Data from reference.⁸ ICANS grade is determined by the most severe event (ICE score, level of consciousness, seizure, motor findings, raised ICP/cerebral edema) not attributable to any other cause; for example, a patient with an ICE score of 3 who has generalized seizure is classified as grade 3 ICANS. *As noted on Table 2. **A patient with an ICE score of 0 may be classified as grade 3 ICANS if awake with global aphasia, but a patient with an ICE score of 0 may be classified as grade 4 ICANS if unarousable. †Depressed level of consciousness should be attributable to no other cause (eg, no sedating medication). ‡Tremors and myoclonus associated with immune effector cell therapies may be graded according to CTCAE v5.0, but they do not influence ICANS grading. ¥Intracranial hemorrhage with or without associated edema is not considered a neurotoxicity feature and is excluded from ICANS grading. It may be graded according to CTCAE v5.0.

Abbreviation: N/A, not applicable.