A review of 60 published cases has mapped the main forms of ICI-CDD, neurological conditions reported after immune checkpoint inhibitor treatment that can affect movement, sensation, sphincter function or vision. Myelitis was the most common presentation, followed by optic neuritis, while 43 of the 60 patients were reported to have favorable outcomes.
What appeared in the reports
The study was a systematic review and pooled analysis of English-language case reports and case series. Database searches ran from inception through 28 March 2026. The analysis brought together 60 patients described in 39 publications. Median age was 58.5 years, ages ranged from 9 to 81, and 35 patients, or 58.3%, were male.
The reported cases did not point to one single presentation. Myelitis appeared in 29 patients, or 48.3% of the 60. Optic neuritis was reported in 19 patients, or 31.7%, and meningoencephalomyelitis in four, or 6.7%.
Among the 40 cases used for that analysis, longitudinally extensive transverse myelitis was reported in 25, or 62.5%. It was defined as lesions spanning at least three vertebral segments. Optic neuritis was typically painless and predominantly bilateral.
Most patients were seronegative for demyelinating antibodies, meaning the reported testing did not detect such an antibody. Among those with detectable antibodies, aquaporin-4 was the most common specificity.
Timing varied widely
ICI-CDD began a median of three months after treatment initiation, but the reported range ran from 0.5 to 60 months. Patients had received a median of four ICI cycles, with reports ranging from one to 95 cycles.
Lung cancer and melanoma were the malignancies most frequently associated with the cases. PD-1 inhibitors were the most commonly implicated ICI class, appearing in 31 of the 60 patients, or 51.7%.
Treatment and what happened next
In the reports, first-line management most often involved corticosteroids and stopping ICI therapy. Corticosteroids were used in 55 of 56 patients, or 98.2%, while ICI treatment was discontinued in 48 of 60, or 80.0%. The two percentages use different denominators, so the figures do not represent identical sets of patients.
Following immunotherapy, favorable outcomes were reported in 43 patients, or 71.7%. Relapse was reported in 10 cases, or 16.7%. The review did not define a favorable outcome or give a follow-up duration, so these figures describe what was recorded in the published cases rather than a forecast for patients outside that collection.
A guide for suspicion, not a risk estimate
The authors say clinicians should suspect ICI-CDD in ICI-treated patients with unexplained weakness in both legs, sensory changes, bladder or bowel control problems, visual loss or visual-field defects. They present demyelinating-antibody detection as support for early identification and prompt personalized immunosuppression as an approach associated with better outcomes.
That recommendation remains an interpretation of case-based evidence. The review's pooled reports cannot establish that antibody testing or immunosuppression improved outcomes, and they cannot show how common ICI-CDD is among all patients receiving immune checkpoint inhibitors or which treatment is best. The 60 cases are therefore most useful as a description of reported clinical patterns, not as an individual risk estimate.
Paper data and sources
Original title: Clinical characteristics, management and outcomes in immune checkpoint inhibitor-induced central nervous system demyelinating disease.
Authors: Zhong-Mian Ma, Wei-Bin Xie, Yan-Lei Hao, Yi-Xiao Li
Journal/Repository: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Status: Peer-reviewed
First online: 2026-08-21
DOI: 10.1007/s10072-026-09342-4
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