PMC9941663_01
Disease course. Clinical manifestations of neurotoxicity, CRS, and ICANS severity, along with the timing of diagnostic investigations and treatment following CAR T-cell therapy, are illustrated. CRS, cytokine release syndrome; ICANS, immune effector-associated neurotoxicity syndrome; CSF, cerebrospinal fluid; ICU, intensive care unit.
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B-cell lymphoma (PMBCL), stage IIXB at diagnosis for mediastinal bulky, refractory to two lines of standard chemotherapy (Figure 1). Before CAR T-cell infusion, she underwent a 30-Gray mediastinal irradiation as a bridge therapy.
Brain MRI findings. Axial (A) and sagittal (B) 1.5 Tesla T2-weighted fluid-attenuated inversion recovery (FLAIR) showed multiple focal punctate areas of hyperintensities localized in the splenium and isthmus of the corpus callosum, with no contrast enhancement or diffusion restriction. Follow-up 3 Tesla brain MRI revealed no T2-weighted abnormalities (images not shown). Yet, diffusion tensor imaging (DTI) showed fractional anisotropy reduction within the corpus callosum's body and splenium (C, D).
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Brain MRI revealed multiple focal punctate areas of T2-weighted fluid-attenuated inversion recovery (FLAIR) hyperintensity localized in the body and isthmus of the corpus callosum, with no contrast enhancement (Figures 2A, B). Remarkably, the follow-up brain MRI (day +13) did not reveal any abnormalities in the corpus callosum, except for a reduction of fractional anisotropy in the diffusion tensor imaging (DTI) sequences (Figures 2C, D).