{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T18:11:59Z","timestamp":1772907119195,"version":"3.50.1"},"reference-count":20,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Br J Haematol"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Immune effector cell\u2010associated neurotoxicity syndrome (ICANS)\u2010associated cognitive impairment is common in patients who receive chimeric antigen receptor T\u2010cell (CAR\u2010T) therapy. This study evaluated the utility of the clock drawing task (CDT) in detecting ICANS in patients with haematological cancers following CAR\u2010T therapy. Data were collected from CAR\u2010T patients at The Alfred Hospital, Melbourne, Australia. Patients underwent frequent assessments using the immune effector cell\u2010associated encephalopathy (ICE) score and the CDT, scored using a modified CLOX (CLOX\u2010M) rating scale, during their admission. We retrospectively reviewed the medical records of consecutive patients who received CAR\u2010T therapy between September 2022 and February 2024 to assess for ICANS and changes in ICE score and CLOX\u2010M. A total of 1208 clock drawings were time matched within an hour of an ICE score for 54 patients (39% female, 64.36\u2009\u00b1\u200913.25\u2009years). Fourteen (26%) patients developed ICANS. Change in CLOX\u2010M scores from baseline and ICE scores was significantly correlated (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.34, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Receiver operating characteristic (ROC) analysis demonstrated that the CLOX\u2010M score has moderate discriminatory power (Area Under the Curve [AUC]\u2009=\u20090.737). A decrease in CLOX\u2010M score of 2 or more had high specificity (0.994) but low sensitivity (0.263) for detecting ICANS. The CDT can be used to complement the ICE score to improve ICANS monitoring.<\/jats:p>","DOI":"10.1111\/bjh.70044","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T07:24:13Z","timestamp":1753687453000},"page":"1495-1503","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["<scp>CLOX<\/scp> and neurotox: Utility of the clock drawing task in monitoring for immune effector cell\u2010associated neurotoxicity syndrome following chimeric antigen receptor T\u2010cell therapy"],"prefix":"10.1111","volume":"207","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6737-5489","authenticated-orcid":false,"given":"Christina","family":"Kazzi","sequence":"first","affiliation":[{"name":"Department of Neuroscience, School of Translational Medicine Monash University  Melbourne Victoria Australia"},{"name":"Department of Neurology Alfred Health  Melbourne Victoria 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