Table 6 Characteristics and management of CAR-T associated CRS
From: Deep insight into cytokine storm: from pathogenesis to treatment
Characteristics Recognition and management | |
|---|---|
Signs and symptoms482 | Initiation: fever with other systemic symptoms (myalgia, fatigue, nausea, vomiting, diarrhea, etc) |
Progress: hypotension, hypoxia, tachycardia, tachypnea, arrhythmia, pleural effusion, capillary leakage, coagulation dysfunction, pulmonary edema, DIC, multiple organ failure | |
Development time482 | Within 14 days of CAR T cell infusion |
The median time for common occurrence is 2–7 days | |
Cytokine profile482 | IL-6, IFN-γ, TNF, GM-CSF, IL-1, IL-2, IL-10, MIP-1, MCP-1,etc |
Risk factor482 | Patient characteristics: disease type, high disease burden, preexisting thrombocytopenia, and endothelial activation |
CAR-T cell product features: targeted CD19, CD28 | |
Co-stimulatory domains, receiving fodarabine and cyclophosphamide, high-dose infusion, high levels of serum CAR-T cells | |
Diagnostic criteria483 | Rule out infectious causes of fever |
CRS scoring | |
Assess ECG, troponin, and BNP levels, atransthoracic echocardiogram for grade 2-4 CRS | |
Management measure482 | Antipyretic, intravenous fluid |
ICU treatment, vasopressor support, supplemental oxygen | |
Anti-IL-6 therapy, glucocorticoid, anakinra, ruxolitinib, emapalumab, antithymocyte globulin, and/or cyclophosphamide | |
