A patient is receiving this immune therapy to treat multiple myeloma. They present with a neurocognitive and hypokinetic movement disorder. What is the agent and what is the proposed mechanism?
Ciltacabtagene autoleucel (cilta-cel). Ciltacabtagene autoleucel and idecabtagene vicleucel are B-cell maturation antigen (BCMA) targeted CAR-T cells and have shown promising results in patients with multiple myeloma. These agents however have an incidence of neurotoxicity of > 18%. It has since been identified that there is localized RNA expression of BCMA in the basal ganglia and the it is hypothesized that the neurotoxicity symptoms are due to CAR-T cell infiltration in the brain targeting BCMA-expressing cells.
Van Oekeln O et al. Neurocognitive and hypokinetic movement disorder with features of parkinsonism after BCMA-targeting CAR-T cell therapy. Nature Medicine 2021 (27): 2099-2103.