The Neurocognitive Impact of CAR T Cell Therapy in Hematological Cancers: A Systematic Review of Cognitive Function, Quality of Life, and Psychological Outcomes
Ashvath Pillai1, Sai Kumar Reddy Pasya2, Megha Tiwari3, Sanjana Patil4, Dhruv Gandhi5, Aparna Nanda6, Sukriti Chugh7, Sumit Chauhan8, Shivangi Jha9
1SSPM Medical College and Lifetime Hospital, 2Kansas University of Medical Centre, 3SIES College of Arts, Science and Commerce, Mumbai, India, 4VydehiInstituteofMedicalSciencesandResearchCentre,Bangalore,India, 5KJSomaiyaMedicalCollegeandResearchCentre,Mumbai,India, 6Indian Institute of Management Bangalore, India, 7Kasturba Medical College, Manipal, India, 8Government Medical College, Patiala, India, 9Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
Objective:
To assess the long-term impact of CAR T-cell therapy on cognitive function, psychological health, and quality of life, focusing on patients developing ICANS.
Background:
CAR T-cell therapy has transformed how we treat blood cancers, giving patients lasting remissions that were previously impossible to achieve. However, patients developed concerning effects on brain function and mental health, especially in patients who develop immune effector cell-associated neurotoxicity syndrome (ICANS).
Design/Methods:
A systematic search was made on PubMed, Embase, and Scopus databases following PRISMA guidelines to ensure thoroughness. Studies included randomized controlled trials, cohort studies, and observational studies that looked at cognitive function, psychological outcomes like anxiety, depression, and PTSD, as well as quality of life after CAR T-cell treatment. Study quality using the Cochrane Risk of Bias Tool for randomized trials and the Newcastle-Ottawa Scale for observational studies.
Results:
Our analysis included eighteen studies that met our criteria. We found that nearly half of CAR T-cell patients (up to 44%) experienced problems with thinking and memory, especially affecting their ability to remember things, pay attention, and make decisions. ICANS occurred in 25–70% of patients, with severe cases affecting 10–20% of recipients. Patients continued to have cognitive problems more than a year after treatment, particularly those who had experienced severe ICANS. Mental health challenges were also common, with 35% of patients developing anxiety and depression, while those with severe neurotoxicity sometimes developed PTSD. Although quality of life generally improved over time, patients with prolonged brain-related side effects took much longer to recover. EEG-based tools like the EICANS Score might help doctors predict who will develop severe ICANS.
Conclusions:
CAR T-cell therapy can cause lasting neurocognitive and psychological problems; therefore, improved systems are needed for ongoing cognitive assessment, standardized evaluation protocols, and targeted rehabilitation to optimize patient outcomes.
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