10
Management
Table 2. ICANS Recommendations
* Immune Effector Cell-Associated Encephalopathy (ICE) Assessment Tool:
• Orientation: orientation to year, month, city, hospital: 4 points
• Naming : ability to name 3 objects (e.g., point to clock, pen, button): 3 points
• Following commands: ability to follow simple commands (e.g., "Show me 2 fingers"
or "Close your eyes and stick out your tongue"): 1 point
• Writing : ability to write a standard sentence (e.g., "Our national bird is the bald
eagle"): 1 point
• Attention: ability to count backwards from 100 by 10: 1 point
¥
For children age <12 years, the Cornell Assessment of Pediatric Delirium (CAPD)
is recommended to aid in the overall grading of ICANS. A CAPD score of ≥9 is
suggestive of delirium and should be considered Grade 3 ICANS. e CAPD score
also may be used in patients age >12 years with baseline developmental delay as it has
been validated up to age 21 years.
** For some products that may be associated with more neurotoxicity (axicabtagene
ciloleucel or bexucabtagene autoleucel) earlier administration of steroids starting at
G1 ICANS and use of high dose steroids at G3 may be an option.
*** ICANS flares have been reported with rapid steroid taper. Close monitoring for
ICANS relapse is encouraged during steroid taper.
**** Noting limited experience with other agents, alternate options for persistent or
worsening ICANS may include anakinra, siltuximab, ruxolitinib, cyclophosphamide,
ATG, or intrathecal hydrocortisone (50 mg ) plus methotrexate (12 mg ).
(cont'd)
