Cognitive Dysfunction associated with Cellular Immunotherapy for Cancer

Immunotherapies engage the individual’s immune system to fight both hematologic and solid malignancies and have led to durable clinical responses for many patients. A subset of immunotherapies, including T cell engagers (TCEs) and chimeric antigen receptor T-cell therapies (CAR-T), use T cell mediated mechanisms to induce cancer cell death. These therapies can be very effective against the cancer while also causing significant systemic and neurologic toxicity including cognitive dysfunction. Here we provide a review on the existing and emerging literature describing the acute, subacute, and potential long-term effects of CAR-T cells and other T-cell engaging therapies on cognition. While the acute effects on cognition, including immune effector cell associated neurotoxicity syndrome (ICANS) are becoming better characterized, there is mixed data on the long-term subjective and objective cognitive outcomes after T-cell based immunotherapies. Further research is needed, especially as these promising and effective therapies become more commonly used for both hematologic and solid malignancies.