# ICANS (neurotoxicity)

Source: https://onco.cc/terms/icans/  
OnCo record `icans` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

ICANS is confusion, speech difficulty, and rarely seizures after CAR-T or bispecific therapy.

## Summary

ICANS, the immune effector cell-associated neurotoxicity syndrome, is the confusion, speech difficulty and occasionally seizures that can follow CAR-T cell therapy or bispecific T-cell engagers. It is more common with CD28-costimulated CAR-T products and is managed with steroids, and a delayed parkinsonism has been seen rarely with BCMA-directed CAR-T such as cilta-cel. The term appears in the Acute lymphoblastic leukaemia, Diffuse large B-cell lymphoma and Multiple myeloma entries and in the drug records for Tisagenlecleucel, Obecabtagene autoleucel, Lisocabtagene maraleucel, Idecabtagene vicleucel and Epcoritamab. It also features in the bottlenecks on toxicity and the limits of the patient, on manufacturing living medicines, and on toxicity and quality of life being undervalued.

## Fields

- Kind: Term
- Last checked: 2026-09-04

## Notes

- Lymphoma: Lymphoma Action says around one person in four treated with engineered T-cell therapy develops neurotoxicity, that it generally appears within 28 days of the infusion and often within a few days, and that symptoms are usually mild and resolve in a week or two. The signs it lists are confusion, speech problems, difficulty writing, headache and dizziness, shaking or tremor, and difficulty moving. Seizures and brain swelling are the serious forms. Someone who develops it is advised not to drive for 8 weeks from the onset of symptoms, and the requirement to have another adult present for the four weeks after infusion exists because the person affected is often the last to notice.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Cytokine_release_syndrome
- ASTCT consensus grading for CRS and ICANS (Lee et al., Biol Blood Marrow Transplant 2019): https://doi.org/10.1016/j.bbmt.2018.12.758
- Lymphoma Action: CAR-T cell therapy: https://lymphoma-action.org.uk/information-and-support/lymphoma-treatment/car-t-cell-therapy

## Connected records

- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Extensive-stage small-cell lung cancer](https://onco.cc/cancers/extensive-stage-sclc/), [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/), [Primary mediastinal (thymic) large B-cell lymphoma](https://onco.cc/cancers/primary-mediastinal-b-cell-lymphoma/), [Relapsed and refractory acute lymphoblastic leukaemia in children](https://onco.cc/cancers/all-paediatric-relapsed/), [Relapsed or refractory multiple myeloma](https://onco.cc/cancers/myeloma-relapsed-refractory/)
- technologies: [CAR-T cell therapy](https://onco.cc/technologies/car-t/), [ICANS, and whether thinking recovers after CAR-T](https://onco.cc/technologies/rejuv-tx-icans-and-neurocognition/), [T-cell engagers (bispecific)](https://onco.cc/technologies/t-cell-engager/)
- key papers: [ASCO 2021 guideline: how to recognise and manage the immune-related side effects of checkpoint inhibitors](https://onco.cc/key-papers/paper-asco-irae-guideline-jco-2021/), [ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells](https://onco.cc/key-papers/paper-lee-biol-blood-marrow-transplant/), [Axicabtagene ciloleucel in relapsed or refractory indolent non-Hodgkin lymphoma (ZUMA-5): a single-arm, multicentre, phase 2 trial](https://onco.cc/key-papers/paper-zuma-5-axi-cel-indolent-lymphoma-lancet-oncol-2022/), [CARTITUDE-1: cilta-cel, a BCMA CAR-T, in heavily pretreated myeloma](https://onco.cc/key-papers/paper-cartitude-1-cilta-cel-lancet-2021/), [DeLLphi-301: tarlatamab, a DLL3-targeting T-cell engager, in previously treated small-cell lung cancer](https://onco.cc/key-papers/paper-dellphi-301-nejm-2023/), [ELIANA: the global trial that made tisagenlecleucel the first approved CAR-T therapy for children and young adults with relapsed ALL](https://onco.cc/key-papers/paper-eliana-tisagenlecleucel-nejm-2018/), [EPCORE NHL-1: epcoritamab, a subcutaneous CD20 x CD3 bispecific, in relapsed large B-cell lymphoma including after CAR-T](https://onco.cc/key-papers/paper-epcore-nhl-1-epcoritamab-jco-2023/), [JULIET: tisagenlecleucel for adults with relapsed or refractory diffuse large B-cell lymphoma](https://onco.cc/key-papers/paper-juliet-tisagenlecleucel-dlbcl-nejm-2019/), [Lisocabtagene maraleucel for patients with relapsed or refractory large B-cell lymphomas (TRANSCEND NHL 001): a multicentre seamless design study](https://onco.cc/key-papers/paper-transcend-nhl-001-liso-cel-lancet-2020/), [Tisagenlecleucel in adult relapsed or refractory follicular lymphoma: the phase 2 ELARA trial](https://onco.cc/key-papers/paper-elara-tisagenlecleucel-follicular-nat-med-2022/), [TRANSFORM: liso-cel CAR-T versus salvage chemotherapy and transplant in early-relapsing large B-cell lymphoma](https://onco.cc/key-papers/paper-transform-liso-cel-lancet-2022/), [ZUMA-1: axicabtagene ciloleucel for refractory large B-cell lymphoma, the first CAR-T approved for lymphoma](https://onco.cc/key-papers/paper-zuma-1-axi-cel-nejm-2017/), [ZUMA-2: brexu-cel CAR-T for mantle cell lymphoma that has failed BTK inhibitors](https://onco.cc/key-papers/paper-zuma-2-brexu-cel-mantle-cell-nejm-2020/), [ZUMA-7: axi-cel CAR-T instead of salvage chemotherapy and transplant for large B-cell lymphoma that relapses early](https://onco.cc/key-papers/paper-zuma-7-axi-cel-second-line-nejm-2022/)
- drugs: [Brexucabtagene autoleucel](https://onco.cc/drugs/brexucabtagene-autoleucel/), [Epcoritamab](https://onco.cc/drugs/epcoritamab/), [Idecabtagene vicleucel](https://onco.cc/drugs/idecabtagene-vicleucel/), [Lisocabtagene maraleucel](https://onco.cc/drugs/lisocabtagene-maraleucel/), [Obecabtagene autoleucel](https://onco.cc/drugs/obecabtagene-autoleucel/), [Talicabtagene autoleucel](https://onco.cc/drugs/talicabtagene-autoleucel/), [Tisagenlecleucel](https://onco.cc/drugs/tisagenlecleucel/), [Varnimcabtagene autoleucel](https://onco.cc/drugs/varnimcabtagene-autoleucel/)
- terms: [CD20 bispecific antibodies: step-up dosing, fixed duration and what it is like to take one](https://onco.cc/terms/lymphoma-tx-bispecific-step-up/), [Cytokine release syndrome and ICANS: grading and management](https://onco.cc/terms/lymphoma-tx-crs-icans/), [Step-up dosing (T-cell engagers)](https://onco.cc/terms/step-up-dosing/), [Transplant or CAR-T at second line in diffuse large B-cell lymphoma](https://onco.cc/terms/lymphoma-decision-transplant-or-car-t/), [Treatment at the local hospital or at a cell-therapy centre far from home](https://onco.cc/terms/lymphoma-decision-local-or-car-t-centre/)
- trials: [ELARA](https://onco.cc/trials/elara/), [JULIET](https://onco.cc/trials/juliet/), [TRANSCEND NHL 001](https://onco.cc/trials/transcend-nhl-001/)
- roadmaps: [Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting](https://onco.cc/roadmaps/lymphoma-roadmap/)
- bottlenecks: [Cachexia, toxicity and the limits of the patient](https://onco.cc/bottlenecks/b-cachexia-supportive/), [Manufacturing cost and time for living and radioactive medicines](https://onco.cc/bottlenecks/b-manufacturing-cell-therapy/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- institutions: [Comprehensive Cancer Center Mainfranken, University Hospital Würzburg](https://onco.cc/institutions/ccc-wuerzburg/), [Society for Immunotherapy of Cancer](https://onco.cc/institutions/sitc/)

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