P08.18.B PROSPECTIVE EVALUATION OF NEUROLOGICAL SAFETY AFTER ANTI-BCMA CAR T-CELL THERAPY IN A SINGLE-CENTRE COHORT

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Abstract BACKGROUND Anti-BCMA (B-cell maturation antigen) chimeric antigen receptor (CAR) T-cell therapy has demonstrated high efficacy in patients with relapsed/refractory multiple myeloma (R/R MM). Acute toxicities, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), typically occur within two weeks of infusion and resolve promptly. However, data on long-term neurological safety remain scarce. Emerging evidence suggests the possibility of movement and neurocognitive treatment-emergent toxicities (MNTs), characterised by irreversible parkinsonism, cognitive impairment, and personality changes, typically arising a median of 36 days [range: 14-914] after CRS/ICANS resolution. This study aims to prospectively assess the long-term neurological safety of ide-cel in R/R MM patients, using standardized cognitive and motor evaluations. MATERIAL AND METHODS We conducted a prospective, systematic neurological evaluation in a cohort of R/R MM patients treated with ide-cel between November 2021 and December 2024 at our center. Only progression-free patients were included. Neurological assessments were performed by a neurologist at baseline (≤2 months before infusion) and at follow-up visits up to 18 months [range 10.5-17.3} post-infusion. Assessments included the Montreal Cognitive Assessment (MoCA) for global cognitive function and the motor subscale of the Unified Parkinson’s Disease Rating Scale (UPDRS) for extrapyramidal symptoms. Pre-treatment brain MRI (<3 months) excluded structural abnormalities. CRS and ICANS were retrospectively recorded. Neurotoxicity triggered further neurological assessment. RESULTS Among 88 patients treated with ide-cel, 40 were excluded due to early relapse, death, or loss to follow-up. Of the 48 eligible patients, 27 remain in follow-up, and 21 have completed full neurological assessments. At baseline, the median MoCA score was 26/30. The highest UPDRS motor score was 4/56, observed in two patients. ICANS was reported in three patients (two Grade 1 and one Grade 4 requiring ICU care). Cognitive and motor scores remained stable between baseline and follow-up assessments, including in those with initially elevated UPDRS scores. CONCLUSION In this real-world, prospective cohort of ide-cel-treated R/R MM patients, no long-term cognitive or motor deterioration was observed up to 18 months post-infusion. Despite the limited number of patients evaluable at this time point, these preliminary findings support the long-term neurological safety of ide-cel when patients are systematically assessed using standardized tools such as the MoCA and UPDRS. Updated results will be presented at the EANO meeting.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.