University of Lynchburg DMSc Doctoral Project Assignment Repository
Specialty
Pediatric Hematology/Oncology
Abstract
Precursor B-cell acute lymphoblastic leukemia is the most common childhood cancer in the U.S. and blinatumomab, a bispecific T-cell engager, has shown promising efficacy with fewer adverse effects than chemotherapy. Immune effector cell-associated neurotoxicity syndrome (ICANS) is a potentially life-threatening complication that can occur with blinatumomab; The Common Terminology Criteria for Adverse Events (CTCAE) guidelines are used for toxicity grading in published pediatric clinical trials investigating blinatumomab, but only recently adapted the guidelines to include ICANS terminology. The American Society for Transplantation and Cellular Therapy released an Immune Effector Cell-Associated Encephalopathy Score to grade ICANS severity in the interim, which is now present within CTCAE guidelines. The purpose of this article is to present a case report of a patient that developed ICANS while receiving blinatumomab, and compare neurotoxicity grading criteria applied in published pediatric clinical trials to more recent grading criteria proposed by the American Society for Transplantation and Cellular Therapy now contained within updated CTCAE guidelines. The comparison highlights differences in grading criteria and reinforces the need for objective, reproducible grading criteria to ensure accurate diagnosis and management. These differences further emphasize the need for continued post-marketing surveillance to accurately capture the frequency of ICANS in pediatric patients receiving blinatumomab.
Recommended Citation
LeVoir C. Neurotoxicity Grading Criteria in a Pediatric Patient Receiving Blinatumomab: A Case Report. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).
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