Edit concept Question Editor Create issue ticket

Cytokine Release Syndrome


Presentation

Sepsis
  • CRS. [2] It appears that interleukin 6 is a key mediator of CRS. [2] Severe CRS or cytokine storms can occur in a number of infectious and non-infectious diseases including graft-versus-host disease (GVHD), acute respiratory distress syndrome (ARDS), sepsis[en.wikipedia.org]
Inflammation
  • IL-1 pathways in inflammation and human diseases. Nat Rev Rheumatol. 2010; 6 (4):232–241. doi: 10.1038/nrrheum.2010.4. [ PubMed ] [ CrossRef ] [ Google Scholar ][ncbi.nlm.nih.gov]
Perseveration
  • Tragedy, Perseverance, and Chance — The Story of CAR-T Therapy. New England Journal of Medicine. 2017; 377 (14):1313–1315. doi: 10.1056/NEJMp1711886. [ PubMed ] [ CrossRef ] [ Google Scholar ] 24. Zhang C, Liu J, Zhong JF, Zhang X.[ncbi.nlm.nih.gov]

Workup

Pulmonary Infiltrate
  • ., renal impairment, pulmonary infiltrates) Grade 4: Life-threatening consequences; pressor or ventilatory support indicated Grade 5: Death Management [ edit ] Treatment for less severe CRS is supportive, addressing the symptoms like fever, muscle pain[en.wikipedia.org]
Hepatocellular Carcinoma
  • A phase I study of anti-GPC3 chimeric antigen receptor modified T cells (GPC3 CAR-T) in Chinese patients with refractory or relapsed GPC3 hepatocellular carcinoma (r/r GPC3 HCC) Journal of Clinical Oncology. 2017; 35 (15_suppl):3049. doi: 10.1200/JCO.2017.35.15[ncbi.nlm.nih.gov]

Treatment

  • It produces complement-dependent and effector cell–mediated lysis, induction of apoptosis, and interference with calcium influx into the cell. 1 Although rituximab is normally a well-tolerated treatment, its systemic administration has been associated[jamanetwork.com]
  • Development and clinical application of anti-HER2 monoclonal and bispecific antibodies for cancer treatment.[ncbi.nlm.nih.gov]
  • […] classifications for CRS as of version 4.03 issued in 2010 were: [2] [9] Grade 1: Mild reaction, infusion interruption not indicated; intervention not indicated Grade 2: Therapy or infusion interruption indicated but responds promptly to symptomatic treatment[en.wikipedia.org]
  • Children and young people may be able to travel to England for treatment. This treatment has not been approved in Scotland for adults with lymphoma.[about-cancer.cancerresearchuk.org]
  • Goal to suppress "overactive" CD8 T-cells/macrophages Future: specific IFN-gamma targeted therapy Grade 3 toxicity: Anti-IL-6 therapy corticosteroids as CRS treatment If does not improve after 48 hrs (controversial; direct evidence in CAR-T-cell-associated[pepidconnect.com]

Etiology

  • ., IL-6, IL-15) Migration of T-cells into the CNS (detection of CAR-T cells in CSF) Etiology/Risk Factors CRS has classically been associated with Therapeutic mAb infusions Most notably anti-CD3 (OKT3) Anti-CD52 (alemtuzumab) 19 anti-CD20 (rituximab)[pepidconnect.com]

Epidemiology

  • CRS and guide dosing for Phase I trials, and regulatory agencies expect to see results of such tests in investigational new drug applications. [4] [10] A modified chandler loop model can be used as a preclinical tool to assess infusion reactions. [1] Epidemiology[en.wikipedia.org]
  • T-cells into the CNS (detection of CAR-T cells in CSF) Etiology/Risk Factors CRS has classically been associated with Therapeutic mAb infusions Most notably anti-CD3 (OKT3) Anti-CD52 (alemtuzumab) 19 anti-CD20 (rituximab) CD28 super-agonist, TGN1412 Epidemiology[pepidconnect.com]
Sex distribution
Age distribution

Pathophysiology

  • CAR-T-cell-related encephalopathy syndrome (CRES) Fulminant CRS may be life-threatening CRS can evolve into fulminant hemophagocytic lymphohistiocytosis (HLH) Also known as macrophage-activation syndrome (MAS) Management of CRS and CRES can be life saving Pathophysiology[pepidconnect.com]

Prevention

  • [ edit ] Severe CRS caused by some drugs can be prevented by using lower doses, infusing slowly, and administering anti-histamines or corticosteroids before and during administration of the drug. [2] In vitro assays have been developed to understand[en.wikipedia.org]
  • […] repeat after 15 min as needed) If Ommaya reservoir Drain CSF until opening pressure 20 mmHg If burst-suppression pattern on EEG Consider neurosurgery consultation and IV anaesthetics Metabolic profiling q6h and daily CT head scan Adjust medications to prevent[pepidconnect.com]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!