Severe ICANS after CAR T-cell therapy and assessment of prevention with levetiracetam for seizure prophylaxis following CAR T-cell for DLBCL & PMBCL in Europe: a survey on behalf of the Cellular Therapy & Immunobiology Working Party (CTIWP) of the EBMT

Chimeric antigen receptor (CAR) T-cells have ushered in a new era of adoptive cell immunotherapies and caused a paradigm shift in the treatment of relapsed and refractory B-cell lymphomas [1]. As of 2024, the European Medicine Agency (EMA) has approved four CAR T-cell products for the treatment of B-cell lymphomas, either diffuse (DLBCL), high-grade (HGBCL), follicular lymphoma (FL), primary mediastinal (PMBCL) or mantle cell lymphoma (MCL): tisagenlecleucel (tisa-cel), axicabtagene ciloleucel (axi-cel), lisocabtagene maraleucel (liso-cel) and brexucabtagene autoleucel (brexu-cel) [2,3,4,5]. Although reference centers are building an increasingly robust experience concerning CAR T-cell administration, acute inflammatory complications, namely cytokine release syndrome (CRS) and immune-effector cell associated neurotoxicity syndrome (ICANS), still pose considerable threats to recipients, restricting access to treatment over fear of unacceptable toxicity or jeopardizing outcomes due to the need for intensive care measure