ICANS可能与细胞因子释放综合症（CRS）同时发生，也可能在CRS消退后不久发生，也有患者在CAR-T细胞输注后长达一个月时间时发生ICANS的延迟性发病。 ICANS通常是自限性的，症状通常持续5至17天。 ICANS的发病时间、持续时间和严重程度可能因CAR产品和患者的疾病状态不同而异。 ICANS的分级系统，整合了免疫效应细胞相关性脑病（ICE）的10级评分标准，在ICE基础上，ICANS分级系统也包括了其他神经系统范围临床症状和体征的评估：意识水平；严重运动无 …

2023年5月18日 · We discuss our approach to managing refractory toxicities that persist or progress beyond initial tocilizumab or corticosteroid administration, delineate risk factors for severe toxicities, highlight the emerging use of anakinra, and review mitigation strategies and supportive care measures to improve outcomes in patients who develop these refra...

2025年3月13日 · Immune effector cell-associated neurotoxicity syndrome (ICANS) and cytokine release syndrome (CRS) are major complications of immune-based cancer therapies, particularly chimeric antigen receptor (CAR) T-cell therapy.

2025年2月7日 · 《nature reviews drug discovery》近日发表综述，总结了CRS和ICANS的治疗现状，并综述了T细胞和骨髓细胞固有的药物靶点和细胞工程化策略，以开发更安全的CAR-T细胞，旨在在保持疗效的同时减轻相关毒性。

Similar to cytokine release syndrome (CRS), the pathophysiology of immune effector cell-associated neurotoxicity syndrome (ICANS) starts with the production of pro-inflammatory cytokines by chimeric antigen receptor (CAR) T cells and the activatoi n of bystander immune cells such as macrophages in the tumor microenvironment.

2024年12月2日 · 鉴于托珠单抗可能存在恶化神经毒性的风险，糖皮质激素治疗icans可能优先于管理低级别crs。托珠单抗可单独用于与1级icans重叠的crs，也可与糖皮质激素联合给药治疗同时具有≥2级icans的crs，但应监测患者的神经毒性恶化，尤其是在重复给药后。

2024年8月14日 · 由于托珠单抗可能存在恶化神经毒性的风险，糖皮质激素治疗icans可能优先于管理低级别crs。对于crs与1级icans重叠，托珠单抗可单独治疗，或与糖皮质激素联合给药用于治疗crs伴≥2级icans，但应监测患者的神经毒性恶化，尤其是在重复给药后（表2）。

2025年2月15日 · CRS and ICANS are significant toxicities in CAR T-cell therapy, with refined diagnostic criteria improving management. CRS management involves early intervention with tocilizumab and corticosteroids, while ICANS relies on corticosteroids.

For patient with early fever (within 72 hrs) or signiicant comorbidities can consider early tocilizumab. Tocilizumab 8 mg/kg (Consider alternative agents after 2 doses) *No more than 3 doses in a 24 hr period or 4 doses in total. Dexamethasone (10 mg q12-24 hrs) with tocilizumab initial tocilizumab.

The guideline offers expert guidance on the diagnosis, evaluation, and management of CRS, ICANS, and other potential but less common toxicities related to CAR T-cell therapy, including hemophagocytic lymphohistiocytosis (HLH), B-cell aplasia, cytopenias, disseminated intravascular coagulation (DIC), and infections.