Chimeric antigen receptor T (CAR-T) cell therapy has demonstrated significant efficacy in the treatment of hematologic malignancies, yet it can lead to severe complications. Intracranial hemorrhage (ICH), although rare, is a particularly lethal outcome. Current research on the risk factors and underlying mechanisms of ICH post-CAR-T therapy remains limited.

This retrospective study analyzed 10 cases of ICH among 2255 patients who underwent CAR-T therapy at Tongji Hospital in Wuhan from January 2015 to December 2024. We collected data on baseline characteristics, CAR-T treatment parameters, inflammatory markers, coagulation function, and clinical outcomes.

The incidence of ICH was 0.44 %, with the median time to onset being 25 days following infusion. All affected patients exhibited thrombocytopenia, and 80 % experienced coagulopathy. Levels of C-reactive protein and Interleukin-6 were significantly elevated before and after treatment. The mortality rate was 90 %, with nine patients succumbing to respiratory and circulatory failure associated with ICH.

The development of ICH after CAR-T therapy is strongly linked to thrombocytopenia, coagulopathy, and the inflammatory response triggered by cytokine release syndrome (CRS). Early identification and proactive management of high-risk patients could potentially improve outcomes. Further prospective studies are necessary to confirm risk prediction models and enhance therapeutic strategies.