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Cytokine Release Syndrome 

Cytokine Release Syndrome 

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Cytokine release syndrome (CRS) is a potentially life-threatening condition that results from the pathologic over-activation of T cells, leading to hypersecretion of cytokines by T cells and other immune cell types. Similar in presentation to a “cytokine storm”, which can be observed across a variety of diseases and treatments, CRS has recently become more formally associated with T-cell–engaging immunotherapies, such as blinatumomab and chimeric antigen receptor T-cell (CAR-T) therapy. At the time of this review, the US Food and Drug Administration (FDA) has approved two CAR-T cell therapies: tisagenlecleucel (approved for relapsed/refractory childhood/adolescent acute lymphoblastic lymphoma and adult relapsed/refractory large B cell lymphoma) [1, 2]  and axicabtagene ciloleucel (approved for relapsed/refractory diffuse large B cell lymphoma). [3] Other CAR-T cell therapies are undergoing clinical trials.

Onset of CRS typically occurs early in the treatment course, within the first 14 days of CAR-T cell infusion or during the first cycle of blinatumomab administration. [4] CRS can last several days, depending on severity and intervention strategies. [5]  

CRS is clinically characterized by fever and malaise, which can progress rapidly to capillary leak, hypoxia, hypotension, vasodilatory shock, and death. [6, 7]  Laboratory markers of systemic inflammation, such as interleukin-6 (IL-6), C-reactive protein (CRP), and ferritin are elevated in response to the hyper-activation of the immune system. While some cytokine profiles have been shown to be predictive of severe CRS, [8]  there is no standard cytokine profile currently utilized to predict CRS severity. [9, 10]

Mild CRS after CAR-T cell infusion often resolves without anti-cytokine intervention and patients are supported with antipyretics and intravenous fluids as needed. Corticosteroids and anti-cytokine–directed therapy with the anti-IL-6 receptor antibody tocilizumab are effective in mitigating CRS. While often reserved for patients with more severe CRS, earlier intervention strategies are being explored. Tocilizumab initially received companion FDA approval for treating CRS with tisagenlecleucel [1]  and is also part of the CRS treatment regimen for axicabtagene ciloleucel.

The terms cytokine storm and CRS have both been used to describe similar syndromes of systemic inflammation that are associated with a variety of diseases and treatments, such as graft versus host disease (GVHD) after allogeneic stem cell transplant, macrophage activation syndrome (MAS)/hemophagocytic lymphohistiocytosis (HLH), idiopathic multicentric Castleman disease (iMCD), and as an adverse event associated with several monoclonal antibody infusions. [11, 12, 13, 14, 15, 16, 17]  However, CRS has been more frequently used to describe a common toxicity in the setting of T-cell–engaging immunotherapies such as CAR-T cells and blinatumomab. [12, 18]  This review will focus on systemic CRS. Its grading and treatment are independent of immune effector cell–associated neurotoxicity (ICANS). [19]

The CRS in CAR-T cell therapy may be biologically distinct from the form seen with blinatumomab, though they likely share many similarities both to each other as well as otto her diseases in which the immune system is hyper-activated. While some studies have suggested that the cytokines are released by the blinatumomab-activated/CAR-T cells, [12]  resulting in a positive feedback loop of T cell activation and inflammatory cytokine release, a recent murine model study has suggested that the cytokines and factors that mediate the severity of CRS, IL-6, IL-1, and nitric oxide are not produced by the CAR-T cells but by recipient macrophages, and can be reversed by IL-1 blockade. [20]  

Abnormal macrophage activation has also been implicated in blinatumomab-related CRS, which also responds to IL-6–directed therapy. [21]  Further studies elucidating the key pathways involved in CRS are needed to develop additional targeted therapeutics for this potentially life-threatening syndrome, especially as the use of CAR-T cell therapies increases in both research settings and routine clinical practice.

CRS occurs in 43-100% of study patients with leukemia or lymphoma receiving CAR-T cell therapy targeted to CD19. [10, 22, 23, 24, 25, 26, 27, 28, 29]  While about 60% of patients in a study of blinatumomab in B-cell acute lymphoblastic leukemia experienced pyrexia, only 2% had grade 3 CRS. [4] The following factors may affect the incidence and severity of CRS in CAR-T cell therapy:

Investigations to mitigate CRS without impacting efficacy are under way, with potential strategies including the following:

CRS can vary widely in severity, from a self-limited febrile illness to life-threatening hypotension and hypoxia requiring support in an intensive care setting. [18]  In addition to the Common Terminology Criteria for Adverse Events (CTCAE version 4.0), several grading scales have been developed for CRS in the context of CAR T cell clinical trials. [5, 26, 40]  The use of these different grading scales has made it challenging to interpret toxicity across trials.

Because of these concerns and a desire for harmonization in the field, the American Society for Transplantation and Cellular Therapy (ASTCT) has developed a consensus grading scale  based on the 3 clinical factors of fever, hypoxia, and hypotension. [19] The ASTCT scale is as follows [19] :

Note the following:

CRS tends to present in the first 2 weeks of CAR T-cell therapy, or the first cycle of treatment with blinatumomab. [4, 10, 23, 24]  A detailed history is important, as patients will present with any or all of the following nonspecific signs and symptoms:

In addition to the above presenting manifestations of CRS, detailed questions regarding possible infectious causes for the patient’s condition are important to consider. Exposure to sick contacts, diarrhea or abdominal complaints, dysuria, or a history of a productive cough may hint at alternative diagnoses that must be considered in the differential.

Physical exam should first focus on a general assessment of the patient’s respiratory status with regard to impending respiratory failure. The use of accessory muscles of inspiration, interval development of inspiratory crackles as a result of pulmonary edema or capillary leak, and confusion as a result of hypercarbia must be considered in this assessment. After the respiratory evaluation, the other vital signs should be evaluated, and re-evaluated early and often once CRS is suspected.

Once the patient is deemed to be stable from a respiratory and circulatory perspective, the exam should focus on ruling out potential sources of infection, such as findings consistent with a new lung consolidation, skin rash/lesion suggesting cellulitis or other dermal source of infection, or the development of new abdominal tenderness or guarding.

CRS is a diagnosis of exclusion. As the syndrome’s presentation is similar to sepsis, systemic infection is at the top of the differential for CRS, especially because patients with relapsed/refractory leukemia/lymphoma are at increased risk for infection. In addition to sepsis, tumor lysis syndrome (TLS) must also be considered, as these patients are also at risk for TLS, and management of TLS requires additional laboratory studies and interventions that are distinct from those for sepsis or CRS. Lastly, progression of the underlying malignancy should be considered as a possibility if only mild symptoms are present.

The approach to evaluating a patient with CRS should accomplish three main goals: ruling out other likely diagnoses, establishing the grade/severity of CRS, and determining the clinical trajectory of the patient. If the laboratory workup is initially concerning for TLS, one should consider additional therapies and lab monitoring for TLS, if they are warranted beyond the fluid resuscitation that would otherwise accompany treatment of CRS (such as allopurinol, rasburicase, or febuxostat).

A complete infectious workup should be obtained, including blood cultures, respiratory viral pathogen analysis, urinalysis, urine culture, and chest x-ray. Laboratory assessment of kidney (blood urea nitrogen [BUN] and creatinine) and liver function tests (LFTs) should be obtained. Arterial blood gas measurement should be considered if the respiratory evaluation warrants it. Uric acid and lactate dehydrogenase (LDH) should also be tested in addition to renal function, to evaluate for possible TLS. If cytokine profiles are clinically available, they may be helpful as baseline values that can then be followed, though results will not typically return soon enough for consideration as part of the immediate work-up and evaluation. Inflammatory acute phase biomarkers such as CRP and ferritin can be measured, as they are often elevated in CRS and correlate with onset and resolution of signs and symptoms.  

A patient with mild CRS (grade 1-2) related to CAR-T cells can be managed with supportive care alone, such as antipyrectics, fluids and supplemental oxygen for mild hypoxia. Patients with low-grade CRS should be closely monitored in an inpatient setting for signs of progression. The management of CRS with T cell engagers, such as blinatumomab, includes the potential to start and stop the drug. Blinatumomab is administered as a continuous infusion with administration of dexamethasone at onset of infusion and at dose escalation to prevent CRS. If mild CRS occurs with blinatumomab, it can be continued with close inpatient monitoring for progression of CRS.  

Severe CRS (grade 3-4) is life-threatening and should be managed in an experienced intensive care unit setting. Concurrent broad antibiotic coverage for presumed sepsis is advised. For severe CRS, blinatumomab should be held until resolution. For adults, reinitiation of blinatumomab should be at the lower dose (9 mcg/day) and patients should be premedicated with dexamethasone. Corticosteroids are also used as a standard treatment for CRS related to blinatumomab.  

In addition to supportive measures, the anti–IL-6 receptor antibody tocilizumab has been approved for use by the FDA in severe/life-threatening CRS, [41]  and is considered standard of care for these cases. Tocilizumab is an effective treatment of CRS for the majority of patients receiving CAR-T cell therapy, and has limited intrinsic toxicity. The optimal time to introduce tocilizumab remains unclear and is the subject of active research. [33, 40]   

Despite limited data, there is concern that corticosteroids could negatively impact the antitumor effects of CAR-T cell therapy, and thus their liberal use in the management of CRS associated with CAR-T cell therapy is not recommended. However, they should be administered in conjunction with tocilizumab for grade 3 or 4 CRS or in the event of tocilizumab failure or concurrent CAR-T cell–related neurotoxicity.   

First-Ever CAR T-cell Therapy Approved in U.S. Cancer Discov. 2017 Oct. 7 (10):OF1. [Medline]. [Full Text].

Iyer RK, Bowles PA, Kim H, Dulgar-Tulloch A. Industrializing Autologous Adoptive Immunotherapies: Manufacturing Advances and Challenges. Front Med (Lausanne). 2018. 5:150. [Medline]. [Full Text].

FDA Approves Second CAR T-cell Therapy. Cancer Discov. 2018 Jan. 8 (1):5-6. [Medline]. [Full Text].

Topp MS, Gökbuget N, Stein AS, et al. Safety and activity of blinatumomab for adult patients with relapsed or refractory B-precursor acute lymphoblastic leukaemia: a multicentre, single-arm, phase 2 study. Lancet Oncol. 2015 Jan. 16 (1):57-66. [Medline].

Porter DL, Hwang WT, Frey NV, Lacey SF, Shaw PA, Loren AW, et al. Chimeric antigen receptor T cells persist and induce sustained remissions in relapsed refractory chronic lymphocytic leukemia. Sci Transl Med. 2015 Sep 2. 7 (303):303ra139. [Medline]. [Full Text].

Maude SL, Barrett D, Teachey DT, Grupp SA. Managing cytokine release syndrome associated with novel T cell-engaging therapies. Cancer J. 2014 Mar-Apr. 20 (2):119-22. [Medline]. [Full Text].

Gore L, Zugmaier G, Handgretinger R, et al. Cytological and molecular remissions with blinatumomab treatment in second or later bone marrow relapse in pediatric acute lymphoblastic leukemia (ALL). J Clin Oncol. 2013. 31(15_suppl):10007-10007. [Full Text].

Teachey DT, Lacey SF, Shaw PA, et al. Identification of Predictive Biomarkers for Cytokine Release Syndrome after Chimeric Antigen Receptor T-cell Therapy for Acute Lymphoblastic Leukemia. Cancer Discov. 2016 Jun. 6 (6):664-79. [Medline]. [Full Text].

Maude SL, Teachey DT, Porter DL, Grupp SA. CD19-targeted chimeric antigen receptor T-cell therapy for acute lymphoblastic leukemia. Blood. 2015 Jun 25. 125 (26):4017-23. [Medline]. [Full Text].

Davila ML, Riviere I, Wang X, et al. Efficacy and toxicity management of 19-28z CAR T cell therapy in B cell acute lymphoblastic leukemia. Sci Transl Med. 2014 Feb 19. 6 (224):224ra25. [Medline]. [Full Text].

Xu XJ, Tang YM, Song H, Yang SL, Xu WQ, Zhao N, et al. Diagnostic accuracy of a specific cytokine pattern in hemophagocytic lymphohistiocytosis in children. J Pediatr. 2012 Jun. 160 (6):984-90.e1. [Medline].

Xu XJ, Tang YM. Cytokine release syndrome in cancer immunotherapy with chimeric antigen receptor engineered T cells. Cancer Lett. 2014 Feb 28. 343 (2):172-8. [Medline].

Xu XJ, Tang YM, Liao C, Song H, Yang SL, Xu WQ, et al. Inflammatory cytokine measurement quickly discriminates gram-negative from gram-positive bacteremia in pediatric hematology/oncology patients with septic shock. Intensive Care Med. 2013 Feb. 39 (2):319-26. [Medline].

Ferrara JL, Abhyankar S, Gilliland DG. Cytokine storm of graft-versus-host disease: a critical effector role for interleukin-1. Transplant Proc. 1993 Feb. 25 (1 Pt 2):1216-7. [Medline].

de Jong MD, Simmons CP, Thanh TT, Hien VM, Smith GJ, Chau TN, et al. Fatal outcome of human influenza A (H5N1) is associated with high viral load and hypercytokinemia. Nat Med. 2006 Oct. 12 (10):1203-7. [Medline]. [Full Text].

Bugelski PJ, Achuthanandam R, Capocasale RJ, Treacy G, Bouman-Thio E. Monoclonal antibody-induced cytokine-release syndrome. Expert Rev Clin Immunol. 2009 Sep. 5 (5):499-521. [Medline].

Fajgenbaum DC. Novel insights and therapeutic approaches in idiopathic multicentric Castleman disease. Blood. 2018 Nov 29. 132 (22):2323-2330. [Medline].

Frey N. Cytokine release syndrome: Who is at risk and how to treat. Best Pract Res Clin Haematol. 2017 Dec. 30 (4):336-340. [Medline].

Lee DW, Santomasso BD, Locke FL, Ghobadi A, Turtle CJ, Brudno JN, et al. ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells. Biol Blood Marrow Transplant. 2019 Apr. 25 (4):625-638. [Medline]. [Full Text].

Giavridis T, van der Stegen SJC, Eyquem J, Hamieh M, Piersigilli A, Sadelain M. CAR T cell-induced cytokine release syndrome is mediated by macrophages and abated by IL-1 blockade. Nat Med. 2018 Jun. 24 (6):731-738. [Medline]. [Full Text].

Teachey DT, Rheingold SR, Maude SL, Zugmaier G, Barrett DM, Seif AE, et al. Cytokine release syndrome after blinatumomab treatment related to abnormal macrophage activation and ameliorated with cytokine-directed therapy. Blood. 2013 Jun 27. 121 (26):5154-7. [Medline]. [Full Text].

Lee DW, Kochenderfer JN, Stetler-Stevenson M, Cui YK, Delbrook C, Feldman SA, et al. T cells expressing CD19 chimeric antigen receptors for acute lymphoblastic leukaemia in children and young adults: a phase 1 dose-escalation trial. Lancet. 2015 Feb 7. 385 (9967):517-528. [Medline].

Maude SL, Frey N, Shaw PA, Aplenc R, Barrett DM, Bunin NJ, et al. Chimeric antigen receptor T cells for sustained remissions in leukemia. N Engl J Med. 2014 Oct 16. 371 (16):1507-17. [Medline]. [Full Text].

Schuster SJ, Svoboda J, Chong EA, Nasta SD, Mato AR, Anak Ö, et al. Chimeric Antigen Receptor T Cells in Refractory B-Cell Lymphomas. N Engl J Med. 2017 Dec 28. 377 (26):2545-2554. [Medline]. [Full Text].

Frey NV, Shaw PA, Hexner EO, Pequignot E, Gill S, Luger SM, et al. Optimizing Chimeric Antigen Receptor T-Cell Therapy for Adults With Acute Lymphoblastic Leukemia. J Clin Oncol. 2020 Feb 10. 38 (5):415-422. [Medline].

Park JH, Rivière I, Gonen M, Wang X, Sénéchal B, Curran KJ, et al. Long-Term Follow-up of CD19 CAR Therapy in Acute Lymphoblastic Leukemia. N Engl J Med. 2018 Feb 1. 378 (5):449-459. [Medline]. [Full Text].

Neelapu SS, Locke FL, Bartlett NL, Lekakis LJ, Miklos DB, Jacobson CA, et al. Axicabtagene Ciloleucel CAR T-Cell Therapy in Refractory Large B-Cell Lymphoma. N Engl J Med. 2017 Dec 28. 377 (26):2531-2544. [Medline]. [Full Text].

Turtle CJ, Hanafi LA, Berger C, Gooley TA, Cherian S, Hudecek M, et al. CD19 CAR-T cells of defined CD4+:CD8+ composition in adult B cell ALL patients. J Clin Invest. 2016 Jun 1. 126 (6):2123-38. [Medline]. [Full Text].

Gardner RA, Ceppi F, Rivers J, Annesley C, Summers C, Taraseviciute A, et al. Preemptive mitigation of CD19 CAR T-cell cytokine release syndrome without attenuation of antileukemic efficacy. Blood. 2019 Dec 12. 134 (24):2149-2158. [Medline].

Milone MC, Fish JD, Carpenito C, Carroll RG, Binder GK, Teachey D, et al. Chimeric receptors containing CD137 signal transduction domains mediate enhanced survival of T cells and increased antileukemic efficacy in vivo. Mol Ther. 2009 Aug. 17 (8):1453-64. [Medline]. [Full Text].

Song DG, Ye Q, Carpenito C, Poussin M, Wang LP, Ji C, et al. In vivo persistence, tumor localization, and antitumor activity of CAR-engineered T cells is enhanced by costimulatory signaling through CD137 (4-1BB). Cancer Res. 2011 Jul 1. 71 (13):4617-27. [Medline]. [Full Text].

Brentjens RJ, Davila ML, Riviere I, Park J, Wang X, Cowell LG, et al. CD19-targeted T cells rapidly induce molecular remissions in adults with chemotherapy-refractory acute lymphoblastic leukemia. Sci Transl Med. 2013 Mar 20. 5 (177):177ra38. [Medline]. [Full Text].

Nellan A, Lee DW. Paving the road ahead for CD19 CAR T-cell therapy. Curr Opin Hematol. 2015 Nov. 22 (6):516-20. [Medline]. [Full Text].

Frey NV, Porter DL. Cytokine release syndrome with novel therapeutics for acute lymphoblastic leukemia. Hematology Am Soc Hematol Educ Program. 2016 Dec 2. 2016 (1):567-572. [Medline]. [Full Text].

Brentjens R, Yeh R, Bernal Y, Riviere I, Sadelain M. Treatment of chronic lymphocytic leukemia with genetically targeted autologous T cells: case report of an unforeseen adverse event in a phase I clinical trial. Mol Ther. 2010 Apr. 18 (4):666-8. [Medline]. [Full Text].

Dahmer MK, Randolph A, Vitali S, Quasney MW. Genetic polymorphisms in sepsis. Pediatr Crit Care Med. 2005 May. 6 (3 Suppl):S61-73. [Medline].

Di Stasi A, Tey SK, Dotti G, Fujita Y, Kennedy-Nasser A, Martinez C, et al. Inducible apoptosis as a safety switch for adoptive cell therapy. N Engl J Med. 2011 Nov 3. 365 (18):1673-83. [Medline]. [Full Text].

Casucci M, Perna SK, Falcone L, Camisa B, Magnani Z, Bernardi M, et al. Graft-versus-leukemia effect of HLA-haploidentical central-memory T-cells expanded with leukemic APCs and modified with a suicide gene. Mol Ther. 2013 Feb. 21 (2):466-75. [Medline]. [Full Text].

Wu CY, Roybal KT, Puchner EM, Onuffer J, Lim WA. Remote control of therapeutic T cells through a small molecule-gated chimeric receptor. Science. 2015 Oct 16. 350 (6258):aab4077. [Medline]. [Full Text].

Lee DW, Gardner R, Porter DL, Louis CU, Ahmed N, Jensen M, et al. Current concepts in the diagnosis and management of cytokine release syndrome. Blood. 2014 Jul 10. 124 (2):188-95. [Medline]. [Full Text].

Actemra (tocilizumab) [package insert]. South San Francisco, CA: Genentech. June 2019. Available at [Full Text].

Nicholas P McAndrew, MD, MSCE Clinical Instructor, Division of Hematology/Oncology, University of California, Los Angeles, David Geffen School of Medicine

Nicholas P McAndrew, MD, MSCE is a member of the following medical societies: American Society of Clinical Oncology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Novartis, Daiichi Sankyo<br/>Serve(d) as a speaker or a member of a speakers bureau for: Novartis<br/>Research funding to my institution for a clinical trial of which I am the PI for: Novartis, Daiichi Sankyo.

Noelle Frey, MD, MSCE Assistant Professor of Medicine, University of Pennsylvania School of Medicine; Associate Director, Bone Marrow Transplant Program, Division of Hematology/Oncology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania

Noelle Frey, MD, MSCE is a member of the following medical societies: American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, American Society of Hematology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Served on Advisory Boards for Novartis; Kite; Servier.

David C Fajgenbaum, MD, MBA, MSc Research Assistant Professor of Medicine, Translational Medicine and Human Genetics, University of Pennsylvania School of Medicine; Associate Director, Patient Impact, Orphan Disease Center, Division of Medical Genetics, Hospital of the University of Pennsylvania

David C Fajgenbaum, MD, MBA, MSc is a member of the following medical societies: American Society of Hematology

Disclosure: Received research grant from: Janssen Pharmaceuticals; EUSA Pharma.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

John Heinegg Editor, eMedicine

Disclosure: Nothing to disclose.

Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences

Disclosure: Nothing to disclose.

Cytokine Release Syndrome 

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