Remote Monitoring for Early Detection of CRS and ICANS in CAR-T Therapy:

A Systematic Review with Geriatric Considerations

S. Ali 1,2; Y. Ismail 1; F. Ahmed 1,2; L. Khalafallah 1; D. Hashim 1,2; N. Naqvi 1; R. Nasraldeen 1; M. Salah 1; N. Abdelrahman 1

1Tele-Geriatric Research Fellowship, Okemos, MI, USA ; 2 University of Medical Sciences and Technology, Khartoum, Sudan

BACKGROUND RESULTS

GERIATRIC CONSIDERATIONS

Cytokine release syndrome (CRS) and immune effector cell-

associated neurotoxicity syndrome (ICANS) are potentially life-

threatening toxicities of CAR-T therapy.

Given their use in malignancies affecting older adults, the

applicability of remote monitoring in this population warrants

evaluation.

OBJECTIVES

Primary Objective:

To assess whether remote monitoring facilitates early detection

of CRS and/or ICANS in patients receiving CAR-T therapy, with

considerations in older adults.

Secondary Objectives:

To characterize remote monitoring modalities used across

studies

To evaluate adherence and feasibility rates in older adult

populations

To assess availability of diagnostic performance metrics

To identify gaps in geriatric-specific evidence for remote

monitoring in CAR-T therapy

METHODOLOGY

Design: Systematic Review following PRISMA-2020 guidelines

Period: 2011-2025

FIGURE 1. PRISMA FLOW

Study Characteristics

380 patients across all 8 studies

Median age: 62–69 years

75% assessed both CRS and ICANS; 25% focused primarily on CRS

Commonest cancers: DLBCL, ALL, multiple myeloma, NHL

FIGURE 2. MONITORING MODALITIES AND REPORTED LEAD TIMES

Study Monitoring Type* Lead Time Reported

S1 (Shafagati et al. 2025) Passive (Apple Watch) 13.75 hours before clinical diagnosis

S2 (Moore et al. 2025) Hybrid S3 (Dholaria et al. 2025) Hybrid (Biofourmis) S4 (Cox et al. 2025) S5 (Cox et al. 2024) S6 (Rajeeve et al. 2023) S7 (Rajeeve et al. 2023) S8 (Dholaria et al. 2023) Hybrid Hybrid Passive (wearable) Passive (wearable) Hybrid Early detection reported, no

quantitative measure

Early detection reported, no

quantitative measure

96–98% detected within 15 days

84% of alarms captured

Median 103 minutes earlier

Median 195–205 minutes earlier

No quantitative nor qualitative

measure

*performance metrics to validate these tools were not reported in any study

FIGURE 3. ADHERENCE RATES

ACROSS INCLUDED STUDIES,

FIGURE 4. RISK OF BIAS

ACROSS INCLUDED STUDIES

Patient ages ranged from 24 to 84 years across all studies

Several studies included patients in their 70s and 80s

Only one study (S2, N=3) enrolled an exclusively older adult population

(age range 65–80 years)

No study performed age-stratified outcome analyses

Adherence rates of 64–80% suggest potential feasibility in older adults

despite limited geriatric-specific data

CONCLUSIONS AND LIMITATIONS

Remote monitoring shows promise for facilitating earlier recognition

of CRS and ICANS and enabling timely intervention.

Adherence rates suggest potential feasibility in older adults, who face

heightened risk for treatment-related complications and barriers to

in-person evaluation.

Dedicated geriatric evidence remains limited to a single study of 3

patients, representing a key gap for future investigation

FUTURE DIRECTIONS

Dedicated trials enrolling older adults including those with functional

or cognitive limitations

Standardized reporting of diagnostic performance metrics

Development of geriatric-specific remote monitoring protocols in

CAR-T pathways

ACKNOWLEDGEMENTS

WHERE REPORTED

I.D.

Records I.D’d from databases (n = 549)

via PubMed, Google Scholar, Cochrane

Duplicates

removed

(n =99)

SCREENING

Records screened (n=450)

Records

excluded

(n =432)

Adherence Rate

ELIGIBILITY

Excluded

(n = 10)

wrong topic or

study design

INCLUDED Reports assessed for eligibility (n=18)

Articles included in review (n = 8)

Analysis: Descriptive synthesis; statistical pooling not performed

due to heterogeneity across monitoring modalities and outcome

reporting

Bias Assessment: Newcastle-Ottawa Scale

100%

80%

60%

40%

20%

0%

S1 S4 S5 S6

Study ID

FIG 3. Adherence rates exceeded 64% across

studies that reported device use; however, four

studies did not report adherence data, limiting

cross-study comparison.

This study is supported by the Tele-Geriatric Research Fellowship, part of

The Combined Research Foundation, Okemos, MI, USA.

NO. OF STUDIES

6

5

4

3

2

1

0

REFERENCES

HIGH MODERATE UNCLEAR

RISK OF BIAS

1- Ochenduszko S, Landete L, Martinez DC, Feria AG, Francés C, Torregrosa MD, Maiques IM. Cytokine

release syndrome and immune effector cell‑associated neurotoxicity syndrome in a melanoma patient

treated with adjuvant pembrolizumab. Exp Ther Med. 2024 Sep 11;28(5):423. doi:

10.3892/etm.2024.12712. PMID: 39301256; PMCID: PMC11412105.

2- Navneet S. Majhail et al. Outpatient Administration of Chimeric Antigen Receptor T-Cell Therapy Using

Remote Patient Monitoring. JCO Oncol Pract 21, 1601-1608(2025).

3- Sterner RC, Sterner RM. Immune effector cell associated neurotoxicity syndrome in chimeric antigen

receptor-T cell therapy. Front Immunol. 2022 Aug 23;13:879608. doi: 10.3389/fimmu.2022.879608. PMID:

36081506; PMCID: PMC9445841.

3-Multiple studies included in the review (n=8)

FIG 4. Risk of bias was assessed using the

Newcastle-Ottawa Scale. Five studies were rated

high risk (S2, S5, S6, S7, S8), two moderate (S1, S3),

and one unclear (S4), reflecting the predominance

of small pilot studies and conference abstracts in

the current evidence base.

CONTACT INFORMATION

Sara Anwar Ali ; saraanwar99@gmail.com