Chemotherapy-induced reversal of ciltacabtagene autoleucel–associated movement and neurocognitive toxicity

TO THE EDITOR:

B-cell maturation antigen (BCMA)-targeting chimeric antigen receptor (CAR) T cells have revolutionized the treatment for patients with relapsed and refractory multiple myeloma, with 2 US Food and Drug Administration–approved products, idecabtagene vicleucel and ciltacabtagene autoleucel (cilta-cel).^1,2 Follow-up of patients receiving cilta-cel in the CARTITUDE-1 study found 82.5% of patients achieved a stringent complete response,³ with a median progression-free survival of 34.9 months.⁴ However, in addition to common complications, like cytokine release syndrome (CRS), immune effector cell–associated neurotoxicity syndrome (ICANS), and prolonged cytopenia seen with other CAR products,^5-9 movement and neurocognitive toxicities (MNTs) have also developed in patients receiving BCMA-targeting CARs.^1,3,10 MNTs occurred in 6% of patients treated in CARTITUDE-1, but they have been less frequent in the more recent cilta-cel trials.^3,11 Risk factors for...