Use of Dasatinib for the Treatment of Refractory Immune Effector Cell-Associated Neurotoxicity Syndrome After Axicabtagene Ciloleucel Infusion: A Case Report

Abstract

Chimeric antigen receptor (CAR) T-cell therapy is a well-established approach for refractory hematological malignancies. Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) remain a major concern of CAR T-cell therapy, particularly in refractory cases where therapeutic options are limited. We report a case of severe, steroid-refractory ICANS following axicabtagene ciloleucel infusion. Despite treatment with anakinra, high-dose methylprednisolone, and intrathecal chemotherapy, no clinical improvement was observed. Only after dasatinib introduction as a fourth-line treatment did the patient show an improvement in ICANS, suggesting the potential benefit of this agent in the management of refractory neurotoxicity after CAR T-cells.

Keywords: CAR‐T cell therapy; Dasatinib; ICANS; diffuse large B‐cell lymphoma; intrathecal chemotherapy; neurotoxicity.