{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T02:25:29Z","timestamp":1787192729606,"version":"build-2736575974"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":216,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment of relapsed\/refractory hematologic malignancies. While immune effector cell-associated neurotoxicity syndrome (ICANS) is a well-recognized complication, expanding clinical use has revealed distinct non-ICANS neurological complications that challenge standard diagnostic and management approaches. We characterize the clinical features and outcomes of these non-classic presentations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted on 357 patients receiving commercial CAR-T therapy for non-Hodgkin lymphoma or multiple myeloma at a single academic center (2015-2025). Non-ICANS neurological complications were defined by neurologic deficits, movement disorders, or neurocognitive syndromes occurring in the absence of global encephalopathy (ICE scores 9-10). Institutional protocol included baseline neurology evaluation and brain MRI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Non-ICANS complications occurred in 17 patients (4.76%). Manifestations included focal neuropathies or myelopathy (n\u2009=\u20095), progressive leukoencephalopathy (n\u2009=\u20094), neuropsychiatric symptoms (n\u2009=\u20093), Parkinsonism (n\u2009=\u20092), and cranial nerve palsies (n\u2009=\u20094). Compared to the institutional median for classic ICANS (7 days), non-ICANS demonstrated a prolonged median duration of 14 days (range, 4-365+ days). Abnormal brain MRI findings were present in 5 of 15 (33.3%) cases with post-treatment brain MRI, manifesting commonly as T2\/FLAIR hyperintensities in the white matter. Cerebrospinal fluid (CSF) immunomonitoring in a subset of cases (n\u2009=\u20092) revealed an enrichment of CAR T-cells compared to peripheral blood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Non-ICANS neurological complications represent a distinct clinical subset characterized by atypical findings, neuroimaging abnormalities, and\/or protracted recovery. Increased clinical vigilance and tailored diagnostic approaches are essential to mitigate long-term morbidity, as standard screening tools fail to capture these focal neurotoxicities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/noajnl\/vdag204","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:45:29Z","timestamp":1785843929000},"source":"Crossref","is-referenced-by-count":0,"title":["Beyond the typical immune effector cell-associated neurotoxicity syndrome: Characterizing non-immune effector cell-associated neurotoxicity syndrome neurological complications in chimeric antigen receptor T-cell therapy\u2014A retrospective analysis"],"prefix":"10.1093","volume":"8","author":[{"given":"Melissa A","family":"Nicholas","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz","family":"Abu-Haimed","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faisal","family":"Abushullaih","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily N","family":"Davidson","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graeme A","family":"Fenton","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin W","family":"Kehm","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakan","family":"Kocoglu","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland,","place":["USA"]},{"name":"Department of Medicine, University of Maryland, Greenebaum Comprehensive Cancer Center , Baltimore, Maryland, (H.K., J.A.Y., A.F., N.M.H., A.P.R., D.A., L.P., A.B., H.A.)","place":["USA"]},{"name":"Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center , Baltimore, Maryland,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5346-6299","authenticated-orcid":false,"given":"Jean A","family":"Yared","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland,","place":["USA"]},{"name":"Department of Medicine, University of Maryland, Greenebaum Comprehensive Cancer Center , Baltimore, Maryland, (H.K., J.A.Y., A.F., N.M.H., A.P.R., D.A., L.P., A.B., H.A.)","place":["USA"]},{"name":"Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center , Baltimore, Maryland,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel","family":"Fromowitz","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland,","place":["USA"]},{"name":"Department of Medicine, University of Maryland, Greenebaum Comprehensive Cancer Center , Baltimore, Maryland, (H.K., J.A.Y., A.F., N.M.H., A.P.R., D.A., L.P., A.B., H.A.)","place":["USA"]},{"name":"Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center , Baltimore, Maryland,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6054-6836","authenticated-orcid":false,"given":"Nancy M","family":"Hardy","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland,","place":["USA"]},{"name":"Department of Medicine, University of Maryland, Greenebaum Comprehensive Cancer Center , Baltimore, Maryland, (H.K., J.A.Y., A.F., N.M.H., A.P.R., D.A., L.P., A.B., H.A.)","place":["USA"]},{"name":"Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center , Baltimore, Maryland,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron P","family":"Rapoport","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland,","place":["USA"]},{"name":"Department of Medicine, University of Maryland, Greenebaum Comprehensive Cancer Center , Baltimore, Maryland, (H.K., J.A.Y., A.F., N.M.H., A.P.R., D.A., L.P., A.B., H.A.)","place":["USA"]},{"name":"Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center , Baltimore, Maryland,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Djordje","family":"Atanackovic","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland,","place":["USA"]},{"name":"Department of Medicine, University of Maryland, Greenebaum Comprehensive Cancer Center , Baltimore, Maryland, (H.K., J.A.Y., A.F., N.M.H., A.P.R., D.A., L.P., A.B., H.A.)","place":["USA"]},{"name":"Transplant and Cellular Therapy Program, University of Maryland Greenebaum Comprehensive Cancer Center , Baltimore, Maryland,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Maryland, Greenebaum Comprehensive Cancer Center , Baltimore, Maryland, (H.K., J.A.Y., A.F., N.M.H., A.P.R., D.A., L.P., A.B., H.A.)","place":["USA"]},{"name":"Department of Neurology, University of Maryland School of Medicine , Baltimore, Maryland,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf","family":"Badros","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland,","place":["USA"]},{"name":"Department of Medicine, University of Maryland, Greenebaum Comprehensive 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