Table 1 Four different stages of the occurrence and progress of CRS in CAR T-cell treatment for B-NHL
From: The model of cytokine release syndrome in CAR T-cell treatment for B-cell non-Hodgkin lymphoma
Stage 1 “Expansion” | Stage 2 “Cytokine surge” | Stage 3 “Redistribution” | Stage 4 “Recovery” | |
|---|---|---|---|---|
CAR T kinetics | CAR T cells in PB increase mildly. Percentage of CAR+ in CD3+ T: 0–20%. | CAR T cells in PB increase rapidly until the peak. Percentage of CAR+ in CD3+ T: 20–95%. | CAR T cells in PB begin to decline. Percentage of CAR+ in CD3+ T: 30–50%. | CAR T cells gradually decrease to a very low level. Percentage of CAR+ in CD3+ T: <20%. |
IL-6 in PB | IL-6 increases mildly, sometimes with a minimal peak. Against baseline: 1–5 times. | IL-6 increases rapidly until the peak. Against baseline: >20 times. | IL-6 gradually declines, sometimes with a secondary peak. Against baseline: 2–20 times. | IL-6 continues to decline to normal. Against baseline: 1–3 times. |
Lesions | Significant swelling and redness. Against baseline: 1–1.2 times (fold change in diameter). | Swelling continues for a period of time, and then the tumours begin to shrink. Against baseline: 0.2–1.5 times (fold change in diameter). | The tumours continue to shrink. Against baseline: 0.1–1.2 times (fold change in diameter). | The tumours disappear or relapse. |
WBC | Continuous decline. Myelosuppression: II–IV. | WBC count gradually increase, accompanied by agranulocytosis. Myelosuppression: III–IV. | After a minimal descending, WBC count gradually increase. Myelosuppression: II–III. | WBC count gets to normal levels. Myelosuppression: II–III. |
ALT/AST | Little change can be observed. | ALT/AST rapidly rises to peak. Against baseline: 2–5 times. | A transient rise of ALT/AST. Against baseline: 1–3 times. | ALT/AST gradually gets to normal. Against baseline: 1–1.5 times. |
B-NHL | ||||
ALL | ||||
