Yan Leyfman, MD, Hematology-Oncology Fellow at NewYork-Presbyterian Brooklyn Methodist Hospital and Executive Director of MedNews Week, shared on LinkedIn:
“CAR-T and T-cell engager therapies have transformed cancer treatment-but as these therapies become more sophisticated, so does the spectrum of immune-related toxicity.
The ASTCT has now updated its consensus definitions and grading criteria for immune effector cell (IEC)-associated toxicities.
The original 2019 framework standardized how we think about CRS and ICANS, giving clinicians and investigators a common language to describe toxicity.
But the field has evolved.
The updated consensus expands the framework to recognize toxicities that extend well beyond CRS and ICANS, including:
- Modified ICE (M-ICE) to facilitate ICANS assessment in children and patients with developmental delays
- Non-ICANS neurotoxicities (NINTs) such as IEC-associated parkinsonism, cranial nerve palsies, and polyneuropathies
- Updated criteria for IEC-associated hematotoxicity (ICAHT)
- Updated definitions for IEC-associated hemophagocytic lymphohistiocytosis-like syndrome (IEC-HS)
- Emerging toxicities including enterocolitis, tumor inflammation-associated neurotoxicity, and on-target/off-tumor toxicities
Importantly, the consensus framework can also be applied to T-cell engager therapies, extending its relevance beyond CAR-T.
Why does this matter?
As cellular therapies move into earlier lines of treatment and new immune effector platforms enter the clinic, toxicity characterization becomes increasingly important-not just for reporting adverse events, but for developing standardized risk stratification, monitoring, and management algorithms.
The next generation of cellular therapy will require more than better engineered immune cells.
It will require a better understanding-and better vocabulary-for the toxicities they can produce.
Standardized grading is not simply a reporting exercise.
It is the foundation for making these therapies safer, more predictable, and more broadly accessible.”
Title: ASTCT Consensus Grading for Toxicities after Immune Effector Cell Therapy
Authors: Miguel-Angel Perales, Jorg Dietrich, Juliane Gust, Bianca Santomasso, Kai Rejeski, Doris Hansen, Nirali N. Shah, Jesus Berdeja, Michael Bishop, Eric Bleickardt, Jennifer Brudno, Saurabh Dahiya, Noelle Frey, Matthew J. Frigault, Rebecca Gardner, Armin Ghobadi, Stephan Grupp, Mehdi Hamadani, Caron Jacobson, Michael D. Jain, Frederick L. Locke
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