18 Questions
What is the first symptom of Cytokine Release Syndrome (CRS)?
Fever
Which biomarker is used as a surrogate for IL-6 activity in CRS?
C-reactive protein (CRP)
What is a common approach to managing CRS?
Use of corticosteroids as a first-line treatment
In CRS, what organ system may also be affected in addition to fever and hypotension?
Cardiovascular system
What is a characteristic feature of Immune effector-associated neurotoxicity syndrome (ICANS) in CRS?
It is classified as a separate entity from CRS
What intervention is recommended for early management of CRS?
Early intervention with tocilizumab
What is the recommended additional medication due to the use of steroids in CRS management?
Bactrim
In the case study, what was the initial treatment for the grade 1 CRS?
Fluid bolus
What role did the APP play in managing CRS in the case study?
Ordered a chest x-ray
What was the result of the chest x-ray in the case study?
Pleural effusions
What was the ANC level that prompted the start of empiric IV antibiotics in the case study?
< 1.0
What additional symptom prompted consultation with the infectious disease team in the case study?
Fever
What is the most severe grade of Cytokine Release Syndrome (CRS) according to the CTCAE v5.0 grading system?
Grade 4
According to ASCO Guidelines, how is Grade 2 CRS managed?
Administer tocilizumab and repeat every 8 hours if no improvement
What symptom is associated with Grade 3 CRS according to ASCO Guidelines?
Hypoxia requiring > 40% FIO2
Which medication may be considered if hypotension persists after tocilizumab and fluid boluses in Grade 2 CRS?
Dexamethasone
What additional action is recommended for management in Grade 3 CRS according to ASCO Guidelines?
Obtain an echocardiogram if not yet done
In the context of CRS management, when should Grade 4 CRS be managed as refractory?
If hypotension persists after tocilizumab and one pressor
Test your knowledge on the 21 ASCO Guideline for managing Cytokine Release Syndrome (CRS) in the context of CAR T-cell therapy. Learn about considerations such as early steroid use, monitoring CD4 counts, adding Bactrim and antifungal prophylaxis.
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