Abdul Mannan: 50% of Patients With Severe ICANS Develop Thrombosis – Here’s What’s Happening
Abdul Mannan, Consultant Haematologist at Betsi Cadwaladr University Health Board, shared a post on LinkedIn:
“50% of patients with severe ICANS develop thrombosis.
That’s not a typo. Compare that to 16% in patients with milder neurotoxicity.
CAR-T therapy is changing how we treat blood cancers. But we’re learning it also changes the blood itself.
Here’s what’s happening:
CAR-T cells activate monocytes, releasing IL-1, IL-6, TNFα, and IL-1β
This cytokine storm damages the endothelium directly
The blood-brain barrier breaks down, and so does vascular stability
You get a perfect storm: bleeding risk AND clotting risk at the same time
The EASIX score helps predict trouble early. A score above 4.67 means 4.3-fold higher odds of severe complications (Korell et al., Blood Advances 2022).
What makes this tricky?
These patients often have prolonged PT, low fibrinogen, and high D-dimers. They look like they’re bleeding. But they’re also clotting.
Classic consumptive coagulopathy.
If you’re managing CAR-T patients, watch the endothelium. The neurotoxicity grade isn’t just about the brain. It’s telling you something about the entire vascular system.
What’s your approach to thromboprophylaxis in severe ICANS cases?”
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