Cytokine release syndrome

Background

  • Systemic inflammatory response syndrome that can be adverse effect of certain immunotherapies, such as monoclonal antibodies and CAR-T therapies (e.g. CART19 for leukemia)
  • Pathophysiology and presentation similar to sepsis
  • Severity ranges from mild flu-like illness to severe sepsis-like inflammatory response with shock, vascular leakage, DIC, and multi-organ system failure[1]

Clinical Features

Differential Diagnosis

  • Sepsis!
  • Hemophagocytic lymphohistiocytosis

Shock

Oncologic Emergencies

Related to Local Tumor Effects

Related to Biochemical Derangement

Related to Hematologic Derangement

Related to Therapy

Evaluation

Hospitals administering CAR-T therapies will often have very specific guidelines for initial workup

Management

Disposition

  • Admit or consider transfer to hospital with oncology

See Also

External Links

https://www.mdcalc.com/cytokine-release-syndrome-crs-grading#evidence

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003181/

  1. Shimabukuro-vornhagen A, Gödel P, Subklewe M, et al. Cytokine release syndrome. J Immunother Cancer. 2018;6(1):56.

Authors:

Claire, Greg