How I treat: current concepts in the diagnosis and management of cytokine release syndrome.

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Abstract:

As immune based therapies for cancer become potent, more effective and more widely available, optimal management of their unique toxicities becomes increasingly important. Cytokine release syndrome (CRS) is a potentially life threatening toxicity that has been observed following administration of natural and bi-specific antibodies and more recently, following adoptive T cell therapies for cancer. CRS is associated with elevated circulating levels of several cytokines including IL-6 and IFNγ, and uncontrolled studies demonstrate that immunosuppression using tocilizumab, an anti-IL6R 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 upon 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.