{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:30:54Z","timestamp":1786739454418,"version":"build-2736575974"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Hypophosphatemia is a common electrolyte abnormality in patients receiving chimeric antigen receptor T-cell (CAR-T) therapy. Its relationship with immune effector cell-associated neurotoxicity syndrome (ICANS) remains incompletely understood. This study investigates the incidence, timing, and clinical correlations of hypophosphatemia and its relationship with ICANS.\n                    <jats:bold>Methods:<\/jats:bold>\n                    We conducted a retrospective chart review of patients who received CAR-T therapy at an academic center. Hypophosphatemia was defined as &lt;2.5\u2009mg\/dL post-CAR-T infusion. The timing of ICANS onset and phosphorus (Pi) nadir were collected. Associations were assessed using chi-square or Fisher\u2019s exact tests. Ordinal logistic regression, linear regression, Cox regression and time-dependent Cox model evaluated the relationship between ICANS and Pi trends.\n                    <jats:bold>Results:<\/jats:bold>\n                    Of 186 CAR-T recipients, 75 had non-Hodgkin\u2019s lymphoma (NHL), 103 had multiple myeloma (MM), and 8 had acute lymphoblastic leukemia. Hypophosphatemia occurred in 71.5% (95% CI: 64.4%\u201377.8%), with an incidence of 82.6% in patients receiving idecabtagene-vicleucel (Abecma) and 75.4% in patients receiving axicabtagene-ciloleucel (Yescarta) (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u20090.002). Among those with hypophosphatemia, mean nadir phosphate was 1.78\u2009mg\/dL (95% CI: 1.7\u20131.84), occurring at a median of 5.94 days post-infusion (95% CI: 5.12\u20136.7; SD 4.78). Hypophosphatemia was associated with increased ICANS risk (hazard ratio 2.87, 95% CI 1.63\u20135.1,\n                    <jats:italic toggle=\"yes\">P\u2009<\/jats:italic>\n                    =\u20090.001) and typically preceded ICANS by a median of 2 days (95% CI: 0.83\u20133.2,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; 0.001 Wilcoxon). In NHL patients, lower nadir phosphate predicted higher ICANS grade (\n                    <jats:italic toggle=\"yes\">\u03b2<\/jats:italic>\n                    \u2009=\u2009\u20131.76,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; 0.001). We concluded that Hypophosphatemia is common post-CAR-T and typically occurs within the first week. Its temporal association with ICANS suggests a potential biological link. Hypophosphatemia may serve as an early predictor of ICANS, warranting further study of phosphate correction as a preventive strategy and potentially a predictor marker.\n                  <\/jats:p>","DOI":"10.4103\/hemoncstem.hemoncstem-d-25-00048","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T09:00:10Z","timestamp":1779440410000},"page":"10-17","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Hypophosphatemia as a Marker for Immune Effector Cell-Associated Neurotoxicity Syndrome in Chimeric Antigen Receptor T Cell Recipients"],"prefix":"10.4103","volume":"19","author":[{"given":"Abedalrahman","family":"Almashayekh","sequence":"first","affiliation":[{"name":"University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samia","family":"Sulaiman","sequence":"additional","affiliation":[{"name":"School of Medicine, The University of Jordan, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdallah","family":"Alaarag","sequence":"additional","affiliation":[{"name":"HCA Florida Healthcare\/USF Morsani College of Medicine, Citrus Hospital, Inverness, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahaf","family":"Omaish","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zelalem","family":"Mekuria","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Balts","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Curran","family":"Henson","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sruthi","family":"Vellanki","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anup","family":"Trikannad","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrett","family":"Spears","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavesh","family":"Mohan-Lal","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshali","family":"Pandey","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adetayo","family":"Odueke","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Schinke","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesar","family":"Gentille-Sanchez","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishank","family":"Jain","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anas","family":"Alshawayat","sequence":"additional","affiliation":[{"name":"Ochsner Medical Center - 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A systematic review of clinical outcomes","volume":"42","author":"Frigault","year":"2023","journal-title":"J Exp Clin Cancer Res CR"},{"key":"R17-20260623","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.bbmt.2018.12.758","article-title":"ASTCT consensus grading for cytokine release syndrome and neurologic toxicity associated with immune effector cells","volume":"25","author":"Lee","year":"2019","journal-title":"Biol Blood Marrow Transplant"},{"key":"R18-20260623","doi-asserted-by":"crossref","first-page":"e14524","DOI":"10.1200\/JCO.2023.41.16_suppl.e14524","article-title":"Hypophosphatemia and thrombocytopenia: a retrospective chart review to identify markers for prediction of CRS and ICANS in CAR T-cell therapy","volume":"41","author":"Barker","year":"2023","journal-title":"J Clin Oncol"},{"key":"R19-20260623","doi-asserted-by":"crossref","first-page":"918","DOI":"10.3390\/cancers17060918","article-title":"Addition of phosphorous and IL6 to m-EASIX score improves detection of ICANS and CRS, as well as CRS progression","volume":"17","author":"Barker","year":"2025","journal-title":"Cancers"},{"key":"R20-20260623","doi-asserted-by":"crossref","first-page":"2589","DOI":"10.1158\/2767-9764.CRC-24-0250","article-title":"Hypophosphatemia correction reduces ICANS incidence and duration in CAR T-cell therapy: a pooled clinical trial analysis","volume":"4","author":"Tang","year":"2024","journal-title":"Cancer Res Commun"},{"key":"R21-20260623","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/j.jcyt.2024.12.014","article-title":"Severe hypophosphatemia following idecabtagene vicleucel regardless of the severity of cytokine release syndrome","volume":"27","author":"Hayashino","year":"2025","journal-title":"Cytotherapy"},{"key":"R22-20260623","doi-asserted-by":"crossref","first-page":"2304","DOI":"10.1093\/ckj\/sfab078","article-title":"Hypophosphatemia in cancer patients","volume":"14","author":"Adhikari","year":"2021","journal-title":"Clin Kidney J"},{"key":"R23-20260623","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1182\/hematology.2020000120","article-title":"Preventing and monitoring for tumor lysis syndrome and other toxicities of venetoclax during treatment of chronic lymphocytic leukemia","volume":"2020","author":"Fischer","year":"2020","journal-title":"Hematology"},{"key":"R24-20260623"},{"key":"R25-20260623","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1179\/1476830515Y.0000000024","article-title":"Using phosphate supplementation to reverse hypophosphatemia and phosphate depletion in neurological disease and disturbance","volume":"19","author":"H\u00e5glin","year":"2016","journal-title":"Nutr Neurosci"},{"key":"R26-20260623","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s11064-025-04604-7","article-title":"ATP metabolism of astrocytes: consumption, regeneration and restoration","volume":"50","author":"Dringen","year":"2025","journal-title":"Neurochem Res"}],"container-title":["Hematology\/Oncology and Stem Cell Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/hemoncstem.hemoncstem-D-25-00048","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T19:29:05Z","timestamp":1786735745000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/hemoncstem.hemoncstem-D-25-00048"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":26,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/hemoncstem.hemoncstem-d-25-00048","relation":{},"ISSN":["1658-3876","2589-0646"],"issn-type":[{"value":"1658-3876","type":"print"},{"value":"2589-0646","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-11-15","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-23","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}