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Case report
Unexpected neurologic complications following a novel lymphoma treatment ‘expected’ to give rise to neurologic toxicity
  1. Marie José Kersten1,
  2. Cornelis N van Ettekoven2 and
  3. Dianne M Heijink3
  1. 1 Department of Haematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
  2. 2 Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  3. 3 Department of Haematology, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Professor Marie José Kersten, M.J.Kersten{at}


Chimeric antigen receptor (CAR) T-cell therapy is a novel and promising form of cellular immunotherapy using genetically engineered, tumour-specific autologous T cells. CD19-specific CAR T-cells have been shown to be very effective as a treatment for relapsed/refractory B-cell acute lymphoblastic leukaemia and aggressive B-cell non-Hodgkin’s lymphoma. ICANS (immune effector cell-associated neurotoxicity syndrome) is one of the most frequently occurring toxicities of CAR T-cell treatment. We describe two cases of patients with neurologic symptoms following CAR T-cell infusion who were suspected to have ICANS, but in fact had cerebral toxoplasmosis and venous sinus thrombosis respectively. The focus on CRS and ICANS after CAR T-cell infusion may lead to less vigilance to the ‘normal’ threats faced by intensively pretreated patients with lymphoma such as infections and thrombosis. Both cases underscore the importance of a broad and thorough examination of patients if they experience neurologic symptoms after CAR T-cell treatment.

  • haematology (drugs and medicines)
  • immunological products and vaccines
  • haematology (incl blood transfusion)
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  • Contributors MJK: planned the case study. All authors treated the patients and acquired and interpreted the data and wrote the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MJ Kersten has received travel support and honoraria for attending advisory boards and presentations for Kite/Gilead and Novartis. The other authors declare no competing interests.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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