Treatment of Multiple Myeloma with Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) After Immune Effector-Based Therapy
In patients with multiple myeloma, immune effector cell-associated neurotoxicity syndrome (ICANS) is a recognised complication that can arise following immune effector-based therapy. Identifying the grade of ICANS promptly and responding with a structured clinical approach is essential.
ICANS is a pathological process affecting the central nervous system that occurs following administration of immune effector-based therapies. It results from the activation or deployment of endogenous or infused T cells and/or other immune effector cells. This scenario specifically addresses its management in the context of multiple myeloma.
For Grade 1 ICANS, the structured response includes supportive measures, adjustment of intake route, and targeted interventions for specific presentations such as agitation. Early use of corticosteroids may be considered in patients at higher risk, and anti-epileptic therapy forms part of the overall plan. The complete graded protocol — including sequencing, agent selection, and decision criteria — is available via the full regimen.
References
DOI: 10.1038/s41571-025-01041-x
- ICANS is a pathological process affecting the CNS following administration of immune effector-based therapies that results from the activation or deployment of endogenous or infused T cells and/or other immune effector cells.
- Agitated patients with grade 1 ICANS might experience symptom improvement with haloperidol or lorazepam [II, B].
- Withhold oral food, medicine and fluid intake and switch to intravenous intake.
- Consider early dexamethasone in high-risk patients [II, B].
- Start non-sedating AEDs if not already being administered [panel consensus; III, C].