What are the limitations of the icans grading?

While the icans grading is highly validated, it should not replace clinical judgment. OpiCalc provides the latest evidence-based limitations for the icans grading to ensure safe bedside use and optimal diagnostic accuracy.

How does the icans grading compare to other Hematology scores?

The icans grading is a gold-standard diagnostic tool. OpiCalc provides side-by-side clinical guidance to help clinicians choose the most specific evidence-based tool for their patient's presentation.

Is the icans grading free to use?

Yes. OpiCalc provides the icans grading completely ad-free and optimized for mobile bedside use, ensuring you can calculate medical risk swiftly and without distraction.

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ICANS Grading (ASTCT 2019)

ICANS Grading (ASTCT): Combined assessment of the ICE score (encephalopathy) and high-risk neuro findings (seizures, raised ICP).

The ICE Score (0-10)

10

Calculated Encephalopathy Points

Orientation (4), Naming (3), Commands (1), Writing (1), Attention (1)

Critical Clinical Findings

ASTCT ICANS Grade

0

No clinical signs of Immune Effector Cell-Associated Neurotoxicity Syndrome.

Guidelines & Evidence

Clinical Details

Section 1

When to Use

Monitoring patients receiving CAR-T cell therapy or other immune effector cell (IEC) therapies.

Grading the severity of Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS).

Determining the threshold for starting corticosteroids (e.g., Dexamethasone) or transitioning to intensive care.

Patient Population

Adult and pediatric patients receiving approved or investigational CAR-T / Bispecific T-cell engager (BiTE) therapies.

Section 2

Formula & Logic

The ICE Score (Encephalopathy)

Task	Points
Orientation (Year, Month, City, Hospital)	4
Naming (3 objects)	3
Following Commands (1 task)	1
Writing (Standard sentence)	1
Attention (Serial 10s from 100)	1

Overall ICANS Grade

Grade	Criteria (Any of)
1	ICE Score 7 - 9
2	ICE Score 3 - 6
3	ICE Score 0 - 2 OR Any Seizure (focal) OR Focal neurological deficit
4	ICE Score 0 (unresponsive) OR Status Epilepticus OR Signs of Elevated ICP (e.g. papilledema)

Section 3

Pearls/Pitfalls

Micrographia

Handwriting assessment (the writing task in the ICE score) is often the first sign of impending ICANS. Changes in penmanship (tremor, micrographia) can precede overt confusion by hours.

Monitoring Frequency

In the high-risk window (typically Days 2–14 post-CAR-T), neuro-checks and ICE scoring should be performed at least every 8–12 hours.

Section 4

Evidence Appraisal

Primary Consensus

ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells.

Lee DW et al. • Biology of Blood and Marrow Transplantation. 2019;25(4):625-638.

View Source

Section 5

Literature

Consensus

Replaced multiple conflicting grading systems (Penn, Lee, MSKCC) to provide a single, universal standard for trial reporting and clinical management.

Last Comprehensive Review: 2026

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