2026 American Academy of Neurology Abstract Website

Objective:

To present a case of paraplegia after CART T-cell therapy in a patient with treatment refractory B-ALL, considering transverse myelitis and spinal cord infarction as possible etiologic entities. To review risk factors and treatment options for this rare condition.

Background:

Immune effector cell-associated neurotoxicity syndrome (ICANS) is a well-documented complication of chimeric antigen receptor T-cell (CAR-T) therapy, typically manifesting as encephalopathy, aphasia, or seizures. However, transverse myelitis (TM) is an exceedingly rare manifestation of ICANS, with few reported cases. Additionally, spinal cord infarction can present with acute bilateral motor, sensory, and autonomic deficits, resembling transverse myelitis and can lead to initial misdiagnosis.

Design/Methods:

We describe the case of a 30-year-old female with B-ALL and KMT2A rearrangement, refractory to standard-of-care corticosteroids, who developed severe, grade 4 ICANS following CAR-T therapy with brexucabtagene autoleucel (Tecartus).

Results:

Patient achieved complete remission with no evidence of disease after a bone marrow transplant. The patient’s imaging was notable for progression spinal cord atrophy. She remains unable to move her legs, but has regained some sensation, and is able to stand with assistance. This case highlights the limitations of the immune effector cell encephalopathy score and demonstrates the need for early MRI evaluation in patients with motor dysfunction post-CAR-T therapy

Conclusions:

This case underscores the importance of developing neuroprotective strategies to mitigate long-term sequelae of ICANS, and adds to the limited literature on CAR-T–related transverse myelitis. In cases within the literature of acute myelopathy following CAR T-cell therapy, the cause is often a non-vascular etiology rather than a spinal cord stroke.