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Abdul Mannan: 50% of Patients With Severe ICANS Develop Thrombosis – Here’s What’s Happening

Dr Abdul Mannan/Linkedin

Jan 4, 2026, 12:54

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?”

Abdul Mannan: 50% of Patients With Severe ICANS Develop Thrombosis - Here's What's Happening