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Chimeric antigen receptor-modified T (CAR T) cell therapy is a highly promising treatment for haematological malignancies but is frequently associated with cytokine release syndrome and neurotoxicity. Between July 2018 and July 2019, all patients treated with CD19-targeted CAR T-cell therapy for relapsing lymphoma were followed-up longitudinally to describe neurological symptoms and their evolution over time. Four different French centres participated and 84 patients (median age 59 years, 31% females) were included. Neurotoxicity, defined as the presence of at least one neurological symptom appearing after treatment infusion, was reported in 43% of the patients. The median time to onset was 7 days after infusion with a median duration of 6 days. More than half of the patients (64%) had grade 1–2 severity and 34% had grade 3–4. CRS was observed in 80% of all patients. The most frequent neurological symptoms were cognitive signs, being severe in 36%, and were equally distributed between language disorders and cognitive disorders without language impairment. Non-pyramidal motor disorders, severe in 11%, were reported in 42% of the patients. Elevation of C-reactive protein (CRP) within 4 days after treatment was significantly correlated with the occurrence of grade 3–4 neurotoxicity. Although sometimes severe, neurotoxicity was almost always reversible. The efficacy of steroids and antiepileptic drugs remains unproven in the management of neurotoxicity. Neurotoxicity associated with CAR T-cell therapies occurs in more than 40% of patients. The clinical pattern is heterogeneous but cognitive disorders (not limited to language disorders) and, to a minor degree, non-pyramidal motor disorders, appeared as a signature of severe neurotoxicity.

Introduction 15 % des myasthenies auto-immune (MAI) sont refractaires et necessitent un traitement immunosuppresseur de seconde ligne. Plusieurs etudes de cas ont montre l’interet du traitement par Rituximab dans la MAI. Objectifs Notre objectif principal est de mettre en evidence l’efficacite du Rituximab dans la MAI refractaire et de decrire sa tolerance. Patients et methodes C’est une etude retrospective multicentrique, de 2011 a 2019. Les criteres d’inclusion sont : score MGFA > II, MAI confirmee (anti-RAch ou anti-Musk ou seronegative confirmee par l’electromyogramme), refractaire ou corticodependante, traite par Rituximab. Pour evaluer l’efficacite, le critere de jugement principal est le score MGFA PIS a 6 mois. Elle est egalement evaluee par le score de Garches et une decroissance des corticoides inferieurs a 10 mg. Les effets indesirables ont ete recueillis. Resultats 27 patients ont ete inclus (19 anti-Rach, 4 anti-Musk et 2 seronegatifs). A 6 mois, 81,4 % ont un score MGFA PIS Improved ou meilleur (p Discussion Le Rituximab a une bonne efficacite dans la MAI a 6 mois et est un traitement epargneur cortisonique. Les patients anti-RAch presentent une bonne efficacite dans notre cohorte (81,4 %), la litterature decrivant habituellement une meilleure efficacite chez les anti Musk+ (50 %). Conclusion Notre travail affirme l’efficacite du Rituximab. Des etudes complementaires seront necessaires pour etablir le positionnement de ce produit dans la pharmacopee de la MAI.