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Objective: Chimeric antigen receptor (CAR) T-cell therapy is a promising treatment for relapsed/refractory acute lymphoblastic leukemia (ALL) in pediatric oncology. However, little is known about the cognitive functioning of these patients. This study examines the neuropsychological functioning of pediatric patients referred for CAR T-cell therapy. Method: Data was obtained from a longitudinal observational study of CAR T-cell therapy patients (ages 1–30 years) at the Children's Hospital of Philadelphia. Neuropsychological data and neurotoxicity ratings were collected before and after CAR T-cell infusion, with brief cognitive testing at 28 days and 180 days post-infusion to assess acute changes. Cognitive testing included pencil-and-paper measures of intellectual functioning, attention, processing speed, and psychological functioning, as well as NIH Toolbox subtests. Results: Of 13 patients completing pre-infusion cognitive testing, 44% of patients scored below average (1 SD below the mean) on a timed visual-motor processing speed test. 20–25% of the sample scored below average on measures of executive functioning, attention/working memory, and expre0111111ssive vocabulary, exceeding what would be expected in a normal distribution. Fewer patients completed post-infusion assessments (n = 8, 28 days; n = 5, 6 months; n = 3, 1 year), with up to 50% scoring below average on the timed visual-motor processing speed test and 33% scoring below average on a measure of inhibitory control and selective attention after 1 year. Conclusions: Pediatric CAR T-cell therapy patients have high rates of cognitive dysfunction prior to receiving infusions, with evidence for increasing problems with timed visual-motor and executive functioning. Findings highlight the need to monitor pediatric CAR T-cell therapy patients throughout treatment. [ABSTRACT FROM AUTHOR]