{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:01:39Z","timestamp":1781154099643,"version":"3.54.1"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Immune effector cell-associated neurotoxicity syndrome (ICANS) is a severe complication of CAR T-cell therapy. Although CAR T-cells have been detected in cerebrospinal fluid (CSF), their viability remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed all patients with grade \u22653 ICANS after commercial CAR T-cell therapy (February 2022 \u2013 September 2025) who underwent lumbar puncture (n=13). CSF was analyzed by flow cytometry including 7-AAD staining for CAR T-cell viability. Viable CAR T-cells were defined as CAR\n                      <jats:sup>+<\/jats:sup>\n                      CD3\n                      <jats:sup>+<\/jats:sup>\n                      7-AAD\n                      <jats:sup>\u2212<\/jats:sup>\n                      lymphocytes. A systematic literature review identified published cases with CSF CAR T-cell detection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 133 CAR T-cell recipients, 28 developed grade \u22653 ICANS and 13 underwent lumbar puncture (total 22 samples). Viability testing was feasible in 11 samples; all contained viable CAR T-cells (median 75%, range 27\u201399%), which remained detectable up to day +98 despite corticosteroid therapy. Median CSF CAR T-cell count was 4.3\/\u00b5L (IQR 1.7\u201318.1). Protein and albumin were elevated in most patients, indicating blood\u2013CSF barrier disruption. A literature review identified 17 published cases reporting CSF findings after CAR T-cell therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>To our knowledge, this is the first study demonstrating that CAR T-cells in the CSF are viable and remain detectable despite corticosteroid therapy. These findings demonstrate the presence of viable CAR T cells in the CSF of patients with ICANS and warrant prospective functional studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1842487","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T04:38:42Z","timestamp":1781152722000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Viable CAR T-cells remain detectable in cerebrospinal fluid in patients with grade \u22653 ICANS despite corticosteroid therapy"],"prefix":"10.3389","volume":"16","author":[{"given":"Alexander Casimir","family":"Angleitner","sequence":"first","affiliation":[{"name":"Department of Hematology and Oncology, University Medical Center G\u00f6ttingen","place":["G\u00f6ttingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Maulhardt","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, University Medical Center G\u00f6ttingen","place":["G\u00f6ttingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Wulf","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, University Medical Center G\u00f6ttingen","place":["G\u00f6ttingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"B\u00fcntzel","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, University Medical Center G\u00f6ttingen","place":["G\u00f6ttingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1056\/nejmoa1804980","article-title":"Tisagenlecleucel in adult relapsed or refractory diffuse large B-cell 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