ICU SAQs · Haematology / immunotherapy
CRS grade 3 after CAR-T — tocilizumab and the ICU management
A CICM SAQ on the CAR-T complications — the CRS grade 3 (the tocilizumab + dexamethasone) and the ICANS (the confusion — the corticosteroids first-line; the tocilizumab does NOT cross the BBB).
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Prompt
A 45-year-old, day 5 post-CAR-T for the refractory DLBCL, develops the fever, the hypotension requiring noradrenaline, and the confusion. Discuss the diagnosis and management.
Question
A 45-year-old, day 5 post-CAR-T for the refractory DLBCL, develops the fever, the hypotension requiring noradrenaline, and the confusion. Discuss the diagnosis and management.[1]
References3ShowHide
- [1]Lee DW, Santomasso BD, Locke FL, et al. ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells. Biol Blood Marrow Transplant, 2019.PMID 30592986
- [2]Le RQ, Li L, Yuan W, et al. FDA Approval Summary: Tocilizumab for Treatment of Chimeric Antigen Receptor T Cell-Induced Severe or Life-Threatening Cytokine Release Syndrome. Oncologist, 2018.PMID 29622697
- [3]Tang XY, Sun Y, Zhang A, et al. Third-generation CD28/4-1BB chimeric antigen receptor T cells for chemotherapy relapsed or refractory acute lymphoblastic leukaemia: a non-randomised, open-label phase I trial protocol. BMJ Open, 2016.PMID 28039295