Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) Consensus Grading for Adults
ASTCT consensus grade for neurotoxicity after CAR T-cell or other immune effector cell therapy.
Overall ICANS grade is set by the most severe of the 5 domains (ICE score, level of consciousness, seizure, motor findings, raised ICP/cerebral edema). Motor findings only contribute at Grade 4 (deep focal weakness); milder motor deficits do not, by themselves, raise the domain grade.
- Overall ICANS grade
- 0
When to use
- Grading neurotoxicity in adults after CD19 or BCMA-directed CAR T-cell therapy or other immune effector cell therapy.
Formula
Overall ICANS grade = the highest (worst) grade among 5 domains: ICE score (7-9=1, 3-6=2, 0-2=3, 0/unarousable=4), depressed consciousness (awakens spontaneously=1, to voice=2, to tactile stimulus=3, unarousable=4), seizure (brief=3, life-threatening/repetitive=4), motor findings (N/A for grades 1-3; deep focal weakness such as hemiparesis/paraparesis=4), and raised ICP/cerebral edema (focal=3, diffuse/herniation signs=4).
Pearls and pitfalls
- Grade 4 is assigned if any single domain reaches grade 4, regardless of the other domains.
- Unlike the other domains, Motor findings has no Grade 1-3 entries in the ASTCT consensus table — it is either not contributory or Grade 4.
- Concurrent cytokine release syndrome should be graded separately using the companion ASTCT CRS grading system.