{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:47:34Z","timestamp":1792090054857,"version":"4.4.0"},"reference-count":16,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Neurohospitalist"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Immune effector cell-associated neurotoxicity syndrome (ICANS) typically manifests within the first week following chimeric antigen receptor (CAR) T-cell therapy and has rarely been described to develop beyond 1 month after treatment. This report describes the occurrence of markedly delayed ICANS in the setting of non-infectious meningoencephalitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We report two cases of markedly delayed ICANS with cerebrospinal fluid (CSF) pleocytosis comprised primarily of CAR T-cells.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Two patients, aged 54 and 67\u00a0years, developed ICANS at 71 and 46\u00a0days, respectively, following administration of ciltacabtagene autoleucel (cilta-cel), a B-cell maturation antigen (BCMA)-directed CAR T-cell therapy. CSF analysis demonstrated elevated total nucleated cell (TNC) counts of 1055 and 605 cells\/\u03bcL, respectively, with marked lymphocytic predominance (94% and 90%), of which 90.4% and 95.4% were CAR T-cells. Both patients improved with corticosteroids and immunotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The identification of CAR T-cells in CSF analysis proved critical for clinical management, enabling early discontinuation of empiric meningeal antimicrobial therapy and implementation of targeted immunosuppressive treatment. This report highlights a rare presentation of markedly delayed ICANS associated with robust infiltration of CAR T-cells into the CSF, expanding our understanding of the temporal spectrum and pathophysiology of ICANS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19418744261496340","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T19:36:26Z","timestamp":1791833786000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Markedly Delayed Onset ICANS in the Setting of CAR T-Cell-Mediated Aseptic Meningoencephalitis: Two Cases"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8689-9624","authenticated-orcid":false,"given":"Andy Y.","family":"Wang","sequence":"first","affiliation":[{"name":"University of California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Suen","sequence":"additional","affiliation":[{"name":"University of California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6924-0641","authenticated-orcid":false,"given":"Iyas","family":"Daghlas","sequence":"additional","affiliation":[{"name":"University of California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anupama","family":"Kumar","sequence":"additional","affiliation":[{"name":"University of California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Oh","sequence":"additional","affiliation":[{"name":"University of California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Pet","sequence":"additional","affiliation":[{"name":"University of California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6955-8297","authenticated-orcid":false,"given":"Vanja","family":"Douglas","sequence":"additional","affiliation":[{"name":"University of California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtct.2024.06.012v"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrclinonc.2017.148"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2024-201783"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2019.08.003"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41408-022-00629-1"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-020-01029-4"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2021004889"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcyt.2024.07.015"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1158\/2159-8290.Cd-17-1319"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2020.08.022"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1158\/2159-8290.Cd-17-0698"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1128\/jvi.00437-24"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1128\/cmr.00021-24"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2023011669"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1159\/000539354"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.26777"}],"container-title":["The Neurohospitalist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19418744261496340","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19418744261496340","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19418744261496340","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:49:01Z","timestamp":1792086541000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19418744261496340"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,12]]},"references-count":16,"alternative-id":["10.1177\/19418744261496340"],"URL":"https:\/\/doi.org\/10.1177\/19418744261496340","relation":{},"ISSN":["1941-8744","1941-8752"],"issn-type":[{"value":"1941-8744","type":"print"},{"value":"1941-8752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,12]]},"article-number":"19418744261496340"}}