Cytokine release syndrome: Difference between revisions
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(Created page with "== Background == * Adverse effect of CAR-T and BiTE therapies == Clinical Manifestations == * Fever, hypotension, tachypnea, tachycardia, headache, rash, dyspnea, hypoxemia == ASTCT CRS GradingCiteRef::lee2019as == {| class="wikitable" !Parameter !Grade 1 !Grade 1 !Grade 3 !Grade 4 |- |Fever |≥38ºC |≥38ºC |≥38ºC |≥38ºC |- | colspan="5" |with |- |Hypotension |— |Not on vasopressors |One vasopressor ± vasopressin |Multiple vasopressors |- | c...")  |
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* Fever, hypotension, tachypnea, tachycardia, headache, rash, dyspnea, hypoxemia |
* Fever, hypotension, tachypnea, tachycardia, headache, rash, dyspnea, hypoxemia |
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* With BiTE, most common after first dose or first few doses |
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* Time of onset is variable |
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** CAR-T: 2-3 days (range 1 to 14 days) |
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** Haploidentical HSCT: 1 to 3 days |
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** Bispecific antibodies: usually within 24-48 hours (range from minutes up to 9 days) |
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=== Prognosis === |
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* Usually resolves within a few days to a few weeks |
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== ASTCT CRS Grading[[CiteRef::lee2019as]] == |
== ASTCT CRS Grading[[CiteRef::lee2019as]] == |
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|Positive-pressure ventilation (non-invasive or invasive) |
|Positive-pressure ventilation (non-invasive or invasive) |
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== Management == |
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* Broad-spectrum antibiotics empirically |
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* Grade 1: supportive care; if persistent fever for 72 hours consider [[tocilizumab]] |
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* Grade 2-4: |
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** [[Tocilizumab]] 8 mg/kg (max 800 mg), can be repeated q8h up to 4 doses; plus |
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** [[Dexamethasone]] 10 mg IV q12h (Grade 2) or q6h (Grades 3 & 4) |
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[[Category:Hematology]] |
[[Category:Hematology]] |
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[[Category:Oncology]] |
[[Category:Oncology]] |
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[[Category:Adverse drug reactions]] |
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Latest revision as of 16:32, 29 March 2024
Background
Clinical Manifestations
- Fever, hypotension, tachypnea, tachycardia, headache, rash, dyspnea, hypoxemia
- With BiTE, most common after first dose or first few doses
- Time of onset is variable
- CAR-T: 2-3 days (range 1 to 14 days)
- Haploidentical HSCT: 1 to 3 days
- Bispecific antibodies: usually within 24-48 hours (range from minutes up to 9 days)
Prognosis
- Usually resolves within a few days to a few weeks
ASTCT CRS Grading1
| Parameter | Grade 1 | Grade 1 | Grade 3 | Grade 4 |
|---|---|---|---|---|
| Fever | ≥38ºC | ≥38ºC | ≥38ºC | ≥38ºC |
| with | ||||
| Hypotension | — | Not on vasopressors | One vasopressor ± vasopressin | Multiple vasopressors |
| and/or | ||||
| Hypoxia | — | Low-flow nasal cannula | High-flow nasal cannula, facemask, nonrebreather mask, Venturi mask | Positive-pressure ventilation (non-invasive or invasive) |
Management
- Broad-spectrum antibiotics empirically
- Grade 1: supportive care; if persistent fever for 72 hours consider tocilizumab
- Grade 2-4:
- Tocilizumab 8 mg/kg (max 800 mg), can be repeated q8h up to 4 doses; plus
- Dexamethasone 10 mg IV q12h (Grade 2) or q6h (Grades 3 & 4)
References
- ^ Daniel W. Lee, Bianca D. Santomasso, Frederick L. Locke, Armin Ghobadi, Cameron J. Turtle, Jennifer N. Brudno, Marcela V. Maus, Jae H. Park, Elena Mead, Steven Pavletic, William Y. Go, Lamis Eldjerou, Rebecca A. Gardner, Noelle Frey, Kevin J. Curran, Karl Peggs, Marcelo Pasquini, John F. DiPersio, Marcel R.M. van den Brink, Krishna V. Komanduri, Stephan A. Grupp, Sattva S. Neelapu. ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells. Biology of Blood and Marrow Transplantation. 2019;25(4):625-638. doi:10.1016/j.bbmt.2018.12.758.
