Boolean Algebra (Mathematical Logic) for Grading of Toxicities Associated with Cellular Immune Therapy
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Abstract
In clinical practice toxicity grading is guided by scales such as the Common Terminology Criteria for Adverse Events. These scales assign grades (usually from 1 to 5) to various toxicities based on severity. Cellular Immunotherapies, whose mechanism of action incudes directing T cells to target cells can be associated with special side effects such as cytokine release syndrome or neurologic toxicity. The American Society for Transplantation and Cellular Therapy has developed an easily applicable, logical and concise system to categorize and grade cytokine release syndrome and neurologic toxicity. Cytokine release syndrome is a systemic inflammatory response that can occur after immune cell therapy. Neurologic toxicity can also occur after immune cell therapy. It can include encephalopathy, delirium, headache, anxiety, sleep disorder, dizziness, aphasia, motor dysfunction, tremor, ataxia, seizure, dyscalculia, myoclonus. Boolean algebra can be used to automate and standardize this grading process by translating it into a mathematical framework that combines different clinical signs and symptoms. In this study we apply Boolean algebra as mathematical tool to define and grade Cytokine release syndrome and neurologic toxicity by the criteria of the American Society for Transplantation and Cellular Therapy.
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