Current concepts in the diagnosis and management of cytokine release syndrome

Daniel W. Lee, Rebecca Gardner, David L. Porter, Chrystal U. Louis, Nabil Ahmed, Michael Jensen, Stephan A. Grupp, Crystal L. Mackall

Research output: Contribution to journalArticlepeer-review

Abstract

As immune-based therapies for cancer become potent, more effective, and more widely available, optimal management of their unique toxicities becomes increasinglyimportant. Cytokinereleasesyndrome (CRS) is a potentially life-threatening toxicity that has been observed following administration of natural and bispecific antibodies and, more recently, following adoptive T-cell therapies for cancer. CRS is associated with elevated circulating levels of several cytokines including interleukin (IL)-6 and interferon γ, and uncontrolled studies demonstrate that immunosuppression using tocilizumab, an anti-IL-6 receptor antibody, with or without corticosteroids, can reverse the syndrome. However, because early and aggressive immunosuppression could limit the efficacy of the immunotherapy, current approaches seek to limit administration of immunosuppressive therapy to patients at risk for life-threatening consequences of the syndrome. This report presents a novel system to grade the severity of CRS in individual patients and a treatment algorithm for management of CRS based on severity. The goal of our approach is to maximize the chance for therapeutic benefit from the immunotherapy while minimizing the risk for life threatening complications of CRS.

Original languageEnglish (US)
Pages (from-to)188-195
Number of pages8
JournalBlood
Volume124
Issue number2
DOIs
StatePublished - Jul 10 2014

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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