Summary of current position articles and guidelines from major societies concerning recommendations on antiepileptic prophylaxis for CAR-T recipients
| Consortium . | Country . | Year . | Recommendation . | Schedule . |
|---|---|---|---|---|
| CARTOX5 | United States | 2017 | Recommended for CAR-T therapies known to cause CAR-T–related encephalopathy syndrome | LVT 750 mg bid |
| ASCO6 | United States | 2021 | Consider in high-risk patients, namely CAR-T products associated with ICANS, or patients at higher risk of seizure, such as those with seizure history, CNS disease, EEG findings, or neoplastic brain lesions | NA |
| EBMT, JACIE, EHA7 | European Union | 2022 | Not recommended except in high-risk cases | NA |
| SFGM-TC8 | France | 2022 | Not recommended in absence of factors suggesting augmented risk of seizures | NA |
| Pan-UK Pharmacy Working Group for ATMPs9 | United Kingdom | 2022 | Prophylaxis should be considered for patients receiving products with a high risk of neurotoxicity and seizures or who have a history of seizures or CNS disease | LVT 500 mg/750 mg bid |
| Chinese expert panel10 | People’s Republic of China | 2023 | Recommended in patients with grade 1 ICANS | LVT 750 mg bid |
| SIE/SIDEM/GITMO11 | Italy | 2023 | In all patients, especially those at high risk, namely those with MCL, previous CNS involvement, previous IT therapies, and/or neurologic comorbidities | LVT 750 mg bid |
| Consortium . | Country . | Year . | Recommendation . | Schedule . |
|---|---|---|---|---|
| CARTOX5 | United States | 2017 | Recommended for CAR-T therapies known to cause CAR-T–related encephalopathy syndrome | LVT 750 mg bid |
| ASCO6 | United States | 2021 | Consider in high-risk patients, namely CAR-T products associated with ICANS, or patients at higher risk of seizure, such as those with seizure history, CNS disease, EEG findings, or neoplastic brain lesions | NA |
| EBMT, JACIE, EHA7 | European Union | 2022 | Not recommended except in high-risk cases | NA |
| SFGM-TC8 | France | 2022 | Not recommended in absence of factors suggesting augmented risk of seizures | NA |
| Pan-UK Pharmacy Working Group for ATMPs9 | United Kingdom | 2022 | Prophylaxis should be considered for patients receiving products with a high risk of neurotoxicity and seizures or who have a history of seizures or CNS disease | LVT 500 mg/750 mg bid |
| Chinese expert panel10 | People’s Republic of China | 2023 | Recommended in patients with grade 1 ICANS | LVT 750 mg bid |
| SIE/SIDEM/GITMO11 | Italy | 2023 | In all patients, especially those at high risk, namely those with MCL, previous CNS involvement, previous IT therapies, and/or neurologic comorbidities | LVT 750 mg bid |
ASCO, American Society of Clinical Oncology; ATMPs, Advanced Medicinal Products; bid, twice daily; EHA, European Hematology Association; GITMO, Gruppo Italiano per il Trapianto di Midollo Osseo; JACIE, Joint Accreditation Committee of International Society for Cell and Gene Therapy; EBMT, European Society for Blood and Marrow Transplantation; MCL, mantle cell lymphoma; NA, not available; SFGM-TC, Société Francophone de Greffe de Moelle et de Thérapie Cellulaire; SIDEM, Società Italiana di Emaferesi e Manipolazione Cellulare; SIE, Socitetà Italiana di Ematologia.