Chimeric antigen receptor (CAR) T-cell therapy is an emerging highly effective treatment for refractory haematological malignancies. Unfortunately, its therapeutic benefit may be hampered by treatment-related toxicities, including neurotoxicity. Early aggressive treatment is paramount to prevent neurological sequelae, yet it potentially interferes with the anti-cancer action of CAR T-cells. We describe four CAR T-cells infused patients who presented with reiterative writing behaviours, namely paligraphia, as an early manifestation of neurotoxicity, and eventually developed frontal predominant encephalopathy (one mild, three severe). Paligraphia may represent an early, specific, and easily detectable clinical finding of CAR T-cell therapy-related neurotoxicity, potentially informing its management.

中文翻译：

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额叶为主的脑病伴早期书写性书写障碍是 CAR T 细胞治疗相关神经毒性的独特特征。

嵌合抗原受体 (CAR) T 细胞疗法是一种新兴的治疗难治性血液系统恶性肿瘤的高效疗法。不幸的是，它的治疗益处可能会受到与治疗相关的毒性（包括神经毒性）的阻碍。早期积极治疗对于预防神经系统后遗症至关重要，但它可能会干扰 CAR T 细胞的抗癌作用。我们描述了四名注入 CAR T 细胞的患者，这些患者出现反复书写行为，即纸质书写，作为神经毒性的早期表现，并最终发展为额叶为主的脑病（一名轻度，三名重度）。Paligraphia 可能代表 CAR T 细胞治疗相关神经毒性的早期、特异性和易于检测的临床发现，可能为其管理提供信息。