# ASTCT ICANS consensus grade (adults) ASTCT ICANS Status: LIVE Price: $0.005 USDC `GET /api/calc/astct_icans` HTML: https://magentlab.com/docs/astct-icans Markdown: https://magentlab.com/docs/astct-icans.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Apply Lee 2019 Table 6 adult ASTCT ICANS consensus grading and return the overall grade (0-4) as the most severe of the ICE, depressed LOC, seizure, motor, and ICP/edema domains, with icans true when grade is 1 or greater. ## When to use When an agent already has a caller-assigned ICE total (0-10), depressed LOC category, seizure category, deep focal motor-weakness flag, and ICP/edema category, and needs the published adult ICANS grade. magent does not perform ICE testing, examine the patient, interpret EEG, or read imaging. Not CRS and not pediatric CAPD. ## When not to use - Not a medical device and not a diagnosis of ICANS. - Adult Lee 2019 Table 6 only. Not pediatric CAPD. Not ASTCT CRS (Lee 2019 Table 1). - ice_score is the caller-assigned ICE total (0-10). magent does not perform orientation, naming, following commands, writing, or attention testing and is not the 10-item ICE calculator. - loc, seizure, motor_weakness, and icp are caller-assigned. magent does not examine the patient, interpret EEG, or read neuroimaging. - Grade uses only findings not attributable to another cause; magent does not determine attribution. - Motor weakness is published as N/A for grades 1-3; true maps to domain grade 4 (deep focal motor weakness such as hemiparesis or paraparesis). ## Formula ``` Adult ASTCT ICANS grade = max of ICE, LOC, seizure, motor, and ICP domains not attributable to another cause (Lee 2019 Table 6). ICE: 10 → 0; 7-9 → 1; 3-6 → 2; 0-2 → 3; ICE 0 is 3 if awake (loc not unarousable) and 4 if unarousable/unable to perform ICE. loc: none 0, spontaneous 1, voice 2, tactile 3, unarousable 4. seizure: none 0, rapidly_resolving 3, life_threatening 4. motor_weakness true → 4 (N/A for grades 1-3), false → 0. icp: none 0, focal_edema 3, diffuse_edema 4. icans iff grade ≥ 1. Not CRS. Not the 10-item ICE test. magent does not perform ICE testing ``` ## Citation [ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells](https://doi.org/10.1016/j.bbmt.2018.12.758) Lee DW, Santomasso BD, Locke FL, Ghobadi A, Turtle CJ, Brudno JN, Maus MV, Park JH, Mead E, Pavletic S, Go WY, Hegde M, Kadauke S, Gauthier J, Riviere I, van den Brink MRM, Gardner RA, Grupp SA, Kalos M, Neelapu SS Biol Blood Marrow Transplant. 2019;25(4):625-638 DOI: [10.1016/j.bbmt.2018.12.758](https://doi.org/10.1016/j.bbmt.2018.12.758) ## Worked example ### ICE 8 with no other domain findings is grade 1 ICANS Given: `ice_score=8, icp=none, loc=none, motor_weakness=false, seizure=none` 1. ice_score 8 is in 7-9 → ICE domain grade 1 2. loc none → 0; seizure none → 0; motor_weakness false → 0; icp none → 0 3. grade = max(1, 0, 0, 0, 0) = 1; icans is true because grade ≥ 1 ## Also searched as - ASTCT ICANS - ICANS grade - immune effector cell-associated neurotoxicity - CAR-T neurotoxicity - ICE score ICANS - Lee 2019 ICANS - ASTCT consensus grading neurotoxicity - adult ICANS Table 6 ## Parameters - `ice_score` (integer, required): Caller-assigned Immune Effector Cell-Associated Encephalopathy (ICE) total 0-10 (Lee 2019 Table 6). Domain: 10 → grade 0; 7-9 → 1; 3-6 → 2; 0-2 → 3. ICE 0 is grade 3 if awake (loc is not unarousable) and grade 4 if unarousable/unable to perform ICE. magent does not score orientation, naming, following commands, writing, or attention and is not the 10-item ICE calculator. - `loc` (string, required): Caller-assigned depressed level of consciousness (Lee 2019 Table 6): none (no depressed LOC, domain 0); spontaneous (awakens spontaneously, 1); voice (awakens to voice, 2); tactile (awakens only to tactile stimulus, 3); unarousable (unarousable or requires vigorous or repetitive tactile stimuli; stupor or coma, 4). Case-insensitive. magent does not examine the patient. - `seizure` (string, required): Caller-assigned seizure (Lee 2019 Table 6): none (domain 0); rapidly_resolving (any clinical seizure, focal or generalized, that resolves rapidly, or nonconvulsive seizures on EEG that resolve with intervention, 3); life_threatening (life-threatening prolonged seizure >5 min or repetitive clinical or electrical seizures without return to baseline, 4). Case-insensitive. magent does not interpret EEG. - `motor_weakness` (boolean, required): Deep focal motor weakness such as hemiparesis or paraparesis as assigned by the caller (Lee 2019 Table 6). true maps to domain grade 4. false maps to 0. Motor is N/A for grades 1-3. true or false. magent does not examine the patient. - `icp` (string, required): Caller-assigned raised intracranial pressure / cerebral edema (Lee 2019 Table 6): none (domain 0); focal_edema (focal/local edema on neuroimaging, 3); diffuse_edema (diffuse cerebral edema on imaging, or decerebrate/decorticate posturing, cranial nerve VI palsy, papilledema, or Cushing triad, 4). Case-insensitive. magent does not read imaging or examine the patient. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/astct_icans` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "ice_score": "8", "icp": "none", "loc": "none", "motor_weakness": "false", "seizure": "none" }, { "ice_score": "8", "icp": "none", "loc": "none", "motor_weakness": "false", "seizure": "none" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/astct-icans Example 200: ```json { "count": 2, "path": "/api/calc/astct_icans", "items": [ { "loc": "none", "components": [ { "value": 1, "factor": "ice", "met": true }, { "value": 0, "factor": "loc", "met": false }, { "value": 0, "factor": "seizure", "met": false }, { "value": 0, "factor": "motor", "met": false }, { "value": 0, "factor": "icp", "met": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Lee DW, Santomasso BD, Locke FL, Ghobadi A, Turtle CJ, Brudno JN, Maus MV, Park JH, Mead E, Pavletic S, Go WY, Hegde M, Kadauke S, Gauthier J, Riviere I, van den Brink MRM, Gardner RA, Grupp SA, Kalos M, Neelapu SS", "doi": "10.1016/j.bbmt.2018.12.758", "id": "lee-2019", "pmid": "30592986", "source": "Biol Blood Marrow Transplant. 2019;25(4):625-638", "title": "ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells" }, "formula": "astct_icans", "formula_expression": "Adult ASTCT ICANS grade = max of ICE, LOC, seizure, motor, and ICP domains not attributable to another cause (Lee 2019 Table 6). ICE: 10 → 0; 7-9 → 1; 3-6 → 2; 0-2 → 3; ICE 0 is 3 if awake (loc not unarousable) and 4 if unarousable/unable to perform ICE. loc: none 0, spontaneous 1, voice 2, tactile 3, unarousable 4. seizure: none 0, rapidly_resolving 3, life_threatening 4. motor_weakness true → 4 (N/A for grades 1-3), false → 0. icp: none 0, focal_edema 3, diffuse_edema 4. icans iff grade ≥ 1. Not CRS. Not the 10-item ICE test. magent does not perform ICE testing", "grade": 1, "icans": true, "ice_grade": 1, "ice_score": 8, "icp": "none", "icp_grade": 0, "loc_grade": 0, "motor_grade": 0, "motor_weakness": false, "seizure": "none", "seizure_grade": 0 }, { "loc": "none", "components": [ { "value": 1, "factor": "ice", "met": true }, { "value": 0, "factor": "loc", "met": false }, { "value": 0, "factor": "seizure", "met": false }, { "value": 0, "factor": "motor", "met": false }, { "value": 0, "factor": "icp", "met": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Lee DW, Santomasso BD, Locke FL, Ghobadi A, Turtle CJ, Brudno JN, Maus MV, Park JH, Mead E, Pavletic S, Go WY, Hegde M, Kadauke S, Gauthier J, Riviere I, van den Brink MRM, Gardner RA, Grupp SA, Kalos M, Neelapu SS", "doi": "10.1016/j.bbmt.2018.12.758", "id": "lee-2019", "pmid": "30592986", "source": "Biol Blood Marrow Transplant. 2019;25(4):625-638", "title": "ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells" }, "formula": "astct_icans", "formula_expression": "Adult ASTCT ICANS grade = max of ICE, LOC, seizure, motor, and ICP domains not attributable to another cause (Lee 2019 Table 6). ICE: 10 → 0; 7-9 → 1; 3-6 → 2; 0-2 → 3; ICE 0 is 3 if awake (loc not unarousable) and 4 if unarousable/unable to perform ICE. loc: none 0, spontaneous 1, voice 2, tactile 3, unarousable 4. seizure: none 0, rapidly_resolving 3, life_threatening 4. motor_weakness true → 4 (N/A for grades 1-3), false → 0. icp: none 0, focal_edema 3, diffuse_edema 4. icans iff grade ≥ 1. Not CRS. Not the 10-item ICE test. magent does not perform ICE testing", "grade": 1, "icans": true, "ice_grade": 1, "ice_score": 8, "icp": "none", "icp_grade": 0, "loc_grade": 0, "motor_grade": 0, "motor_weakness": false, "seizure": "none", "seizure_grade": 0 } ] } ``` ## Response fields - `formula` (string): astct_icans - `formula_expression` (string): Published Lee 2019 Table 6 adult ICANS max-of-domains rule - `ice_score` (integer): Echo of the caller-assigned ICE total 0-10 - `loc` (string): Canonical LOC token: none, spontaneous, voice, tactile, or unarousable - `seizure` (string): Canonical seizure token: none, rapidly_resolving, or life_threatening - `motor_weakness` (boolean): Echo of the caller-assigned deep focal motor weakness flag - `icp` (string): Canonical ICP token: none, focal_edema, or diffuse_edema - `ice_grade` (integer): ICE domain grade 0-4 (ICE 0 is 4 when loc is unarousable) - `loc_grade` (integer): LOC domain grade 0-4 - `seizure_grade` (integer): Seizure domain grade 0, 3, or 4 - `motor_grade` (integer): Motor domain grade 0 or 4 - `icp_grade` (integer): ICP domain grade 0, 3, or 4 - `grade` (integer): Overall ASTCT ICANS grade 0-4 = max of the five domain grades. Not a diagnosis. - `icans` (boolean): true iff grade is 1 or greater - `components` (array): Rows for ice, loc, seizure, motor, and icp with factor, met (domain grade > 0), and value (the domain grade) - `citation` (object): Lee 2019 Biol Blood Marrow Transplant citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "loc": "none", "components": [ { "value": 1, "factor": "ice", "met": true }, { "value": 0, "factor": "loc", "met": false }, { "value": 0, "factor": "seizure", "met": false }, { "value": 0, "factor": "motor", "met": false }, { "value": 0, "factor": "icp", "met": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Lee DW, Santomasso BD, Locke FL, Ghobadi A, Turtle CJ, Brudno JN, Maus MV, Park JH, Mead E, Pavletic S, Go WY, Hegde M, Kadauke S, Gauthier J, Riviere I, van den Brink MRM, Gardner RA, Grupp SA, Kalos M, Neelapu SS", "doi": "10.1016/j.bbmt.2018.12.758", "id": "lee-2019", "pmid": "30592986", "source": "Biol Blood Marrow Transplant. 2019;25(4):625-638", "title": "ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells" }, "formula": "astct_icans", "formula_expression": "Adult ASTCT ICANS grade = max of ICE, LOC, seizure, motor, and ICP domains not attributable to another cause (Lee 2019 Table 6). ICE: 10 → 0; 7-9 → 1; 3-6 → 2; 0-2 → 3; ICE 0 is 3 if awake (loc not unarousable) and 4 if unarousable/unable to perform ICE. loc: none 0, spontaneous 1, voice 2, tactile 3, unarousable 4. seizure: none 0, rapidly_resolving 3, life_threatening 4. motor_weakness true → 4 (N/A for grades 1-3), false → 0. icp: none 0, focal_edema 3, diffuse_edema 4. icans iff grade ≥ 1. Not CRS. Not the 10-item ICE test. magent does not perform ICE testing", "grade": 1, "icans": true, "ice_grade": 1, "ice_score": 8, "icp": "none", "icp_grade": 0, "loc_grade": 0, "motor_grade": 0, "motor_weakness": false, "seizure": "none", "seizure_grade": 0 } ``` ## Errors - HTTP 400 `invalid_astct_icans`: ice_score must be an integer 0–10; loc none, spontaneous, voice, tactile, or unarousable; seizure none, rapidly_resolving, or life_threatening; icp none, focal_edema, or diffuse_edema (Lee 2019 ASTCT ICANS Table 6). Returned before settlement; you are not charged. - HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [WHO 2016 PV criteria](https://magentlab.com/docs/who-pv) — Apply the Arber 2016 / WHO 2016 polycythemia vera diagnostic criteria and return whether the published combination of three majors, or major 1 and major 2 plus subnormal EPO, is met. - [MIPSS70](https://magentlab.com/docs/mipss70) — Sum the Guglielmelli 2018 MIPSS70 (mutation-enhanced international prognostic score system) for transplantation-age primary myelofibrosis and return low (0–1), intermediate (2–4), or high (≥5). - [Glasgow Coma Scale](https://magentlab.com/docs/gcs) — Compute the Glasgow Coma Scale as the sum of caller-assigned eye, verbal, and motor integers. The 1974 or 1976 edition is required. ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.