{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T10:47:03Z","timestamp":1787827623644,"version":"build-2784847793"},"reference-count":18,"publisher":"American Society of Hematology","issue":"13","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,9,26]]},"abstract":"<jats:sec>\n                  <jats:title>Abstract<\/jats:title>\n                  <jats:p>Immune effector cell\u2013associated neurotoxicity syndrome (ICANS) is a common but potentially severe adverse event associated with chimeric antigen receptor T-cell (CART) therapy, characterized by the development of acute neurologic symptoms following CART infusion. ICANS encompasses a wide clinical spectrum typified by mild to severe encephalopathy, seizures, and\/or cerebral edema. As more patients have been treated with CART, new ICANS phenomenology has emerged. We present the clinical course of 5 children who developed acute onset of quadriparesis or paraparesis associated with abnormal brain and\/or spine neuroimaging after infusion of CD19- or CD22-directed CART, adverse events not previously reported in children. Orthogonal data from autopsy studies, cerebrospinal fluid (CSF) flow cytometry, and CSF proteomics\/cytokine profiling demonstrated chronic white matter destruction, but a notable lack of inflammatory pathologic changes and cell populations. Instead, children with quadriparesis or paraparesis post-CART therapy had lower levels of proinflammatory cytokines, such as interferon gamma, CCL17, CCL23, and CXCL10, than those who did not develop quadriparesis or paraparesis. Taken together, these findings imply a noninflammatory source of this newly described ICANS phenomenon in children. The pathophysiology of some neurologic symptoms following CART may therefore have a more complex etiology than exclusive T-cell activation and excessive cytokine production.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1182\/blood.2024023933","type":"journal-article","created":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T20:55:19Z","timestamp":1719003319000},"page":"1387-1398","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":22,"title":["Quadriparesis and paraparesis following chimeric antigen receptor T-cell therapy in children and adolescents"],"prefix":"10.1182","volume":"144","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8005-3836","authenticated-orcid":false,"given":"Caroline","family":"Diorio","sequence":"first","affiliation":[{"name":"1Immune Dysregulation Frontier Program, Department of Pediatrics, Children\u2019s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"},{"name":"2Division of Oncology, Department of Pediatrics, Children\u2019s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"},{"name":"3Susan S. and Stephen P. Kelly Center for Cancer Immunotherapy, Children\u2019s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Hernandez-Miyares","sequence":"additional","affiliation":[{"name":"4Division of Neurology, Departments of Neurology and Pediatrics, Children\u2019s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego A.","family":"Espinoza","sequence":"additional","affiliation":[{"name":"5Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda L.","family":"Banwell","sequence":"additional","affiliation":[{"name":"1Immune Dysregulation Frontier Program, Department of Pediatrics, Children\u2019s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"},{"name":"4Division of Neurology, Departments of Neurology and Pediatrics, Children\u2019s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"},{"name":"5Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7179-0335","authenticated-orcid":false,"given":"Amit","family":"Bar-Or","sequence":"additional","affiliation":[{"name":"5Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"},{"name":"6Center for Neuroinflammation and Experimental Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda M.","family":"DiNofia","sequence":"additional","affiliation":[{"name":"2Division of Oncology, Department of Pediatrics, Children\u2019s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"},{"name":"3Susan S. and Stephen P. 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