Cytokine release syndrome (CRS) is a key safety risk associated with therapies relying on T-cell engagers including CAR-T & BiTE® molecules. Various authors and groups have devised severity grading conventions from an immediate management perspective. This discussion will be an attempt to compare different CRS grading criteria, relate them to current CRS management & discuss the best practices.
Method
T-Cell Engagers (TCE’s) are one of the most promising treatment modalities for the cure of multiple, solid and hematological tumors which we earlier thought were incurable diseases. Due to the mechanism of action of these molecules, whereby, it engages T-cells towards the target cancer cells, it sometimes causes hyperinflammatory conditions releasing cytokines affecting multiple organs/organ systems. The mechanism behind the cytokine release in such conditions is known. Its diagnosis and treatment, however, is challenging and require continuous monitoring to ensure the appropriate management of this severe condition before it starts deteriorating or affecting multiple organs. Since the early diagnosis of CRS is primarily based on clinical acumen, the available CRS grading criteria drive the diagnosis and management. Although CRS grading criteria have the common objective, primarily targeted towards an immediate management of the event, consensus towards a single grading criterion might vary. My presentation will be based on a review of published literature and comprises 3 parts:
- Comparing CRS grading methodologies, observations, and features driving the conclusion.
- Justification towards an early management and mitigation plan based on available CRS grading
criteria
- Discuss best practices and potential areas for further follow up/improvement to ensure optimal
patient safety.
