Cytokine Release Syndrome (CRS) is a moderate immune response brought on by pro-inflammatory cytokines being released in massive numbers. This is seen especially after receiving any type immunotherapy, including Car-T cell therapy. This is a complex adverse event where patients must be monitored for the first 8 weeks post-infusion.
What sets this condition apart from others is that this occurs AFTER RECEIVING CAR-T THERAPY
The three most noticeable symptoms usually seen in CRS is fever, shortness of breath and hypotension
(Goldkuhle et al., 2018; Lee et al., 2019; Schuster et al., 2019).
CRS progresses in stages and if it is not treated promptly at the beginning, it will rapidly progress to the next stage
CRS Grading Scale
| CRS Parameter | Grade 1 | Grade 2 | Grade 3 | Grade 4 |
|---|---|---|---|---|
| Fever | Temperature >= 38°C | Temperature >= 38°C | Temperature >= 38°C | Temperature >= 38°C |
| Hypotension | None | Not requiring vasopressors | Requiring a vasopressor with or without vasopressin | Requiring multiple vasopressors (excluding vasopressin) |
| Hypoxia | None | Requiring low-flow nasal cannula or blow-by | Requiring high-flow nasal cannula, facemask, nonrebreather mask, or Venturi mask | Requiring positive pressure (eg, CPAP, BiPAP, intubation and mechanical ventilation) |
American Society for Blood and Marrow Transplantation (ASBMT) has clarified the following:
“Fever is defined as temperature 38°C not attributable to any other cause. In patients who have CRS then receive antipyretics or anticytokine therapy such as tocilizumab or steroids, fever is no longer required to grade subsequent CRS severity. In this case, CRS grading is driven by hypotension and/or hypoxia”
CRS grade is determined by the more severe event: hypotension or hypoxia not attributable to any other cause. For example, a patient with temperature of 39.5°C, hypotension requiring 1 vasopressor, and hypoxia requiring low-flow nasal cannula is classified as grade 3 CRS “
(Lee et al, 2019; Porter et al, 2018)
Use the following questionnaire to identify the symptoms of CRS and the recommended management guidelines