Podcast
Questions and Answers
What is the first symptom of Cytokine Release Syndrome (CRS)?
What is the first symptom of Cytokine Release Syndrome (CRS)?
Which biomarker is used as a surrogate for IL-6 activity in CRS?
Which biomarker is used as a surrogate for IL-6 activity in CRS?
What is a common approach to managing CRS?
What is a common approach to managing CRS?
In CRS, what organ system may also be affected in addition to fever and hypotension?
In CRS, what organ system may also be affected in addition to fever and hypotension?
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What is a characteristic feature of Immune effector-associated neurotoxicity syndrome (ICANS) in CRS?
What is a characteristic feature of Immune effector-associated neurotoxicity syndrome (ICANS) in CRS?
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What intervention is recommended for early management of CRS?
What intervention is recommended for early management of CRS?
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What is the recommended additional medication due to the use of steroids in CRS management?
What is the recommended additional medication due to the use of steroids in CRS management?
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In the case study, what was the initial treatment for the grade 1 CRS?
In the case study, what was the initial treatment for the grade 1 CRS?
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What role did the APP play in managing CRS in the case study?
What role did the APP play in managing CRS in the case study?
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What was the result of the chest x-ray in the case study?
What was the result of the chest x-ray in the case study?
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What was the ANC level that prompted the start of empiric IV antibiotics in the case study?
What was the ANC level that prompted the start of empiric IV antibiotics in the case study?
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What additional symptom prompted consultation with the infectious disease team in the case study?
What additional symptom prompted consultation with the infectious disease team in the case study?
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What is the most severe grade of Cytokine Release Syndrome (CRS) according to the CTCAE v5.0 grading system?
What is the most severe grade of Cytokine Release Syndrome (CRS) according to the CTCAE v5.0 grading system?
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According to ASCO Guidelines, how is Grade 2 CRS managed?
According to ASCO Guidelines, how is Grade 2 CRS managed?
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What symptom is associated with Grade 3 CRS according to ASCO Guidelines?
What symptom is associated with Grade 3 CRS according to ASCO Guidelines?
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Which medication may be considered if hypotension persists after tocilizumab and fluid boluses in Grade 2 CRS?
Which medication may be considered if hypotension persists after tocilizumab and fluid boluses in Grade 2 CRS?
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What additional action is recommended for management in Grade 3 CRS according to ASCO Guidelines?
What additional action is recommended for management in Grade 3 CRS according to ASCO Guidelines?
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In the context of CRS management, when should Grade 4 CRS be managed as refractory?
In the context of CRS management, when should Grade 4 CRS be managed as refractory?
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Study Notes
Cytokine Release Syndrome (CRS) Overview
- The first symptom of CRS is often fever.
- A key biomarker used as a surrogate for IL-6 activity in CRS is serum C-reactive protein (CRP).
Management of CRS
- Common approaches to managing CRS include monitoring and supportive care.
- Organ systems affected in CRS can include the neurological system, in addition to fever and hypotension.
- Immune effector-associated neurotoxicity syndrome (ICANS) is characterized by encephalopathy and neurological impairments.
Early Management Interventions
- Early intervention in CRS management often includes the administration of tocilizumab.
- Due to steroid use in CRS management, additional medications like short-acting insulin may be recommended to manage hyperglycemia.
Case Study Insights
- Initial treatment for grade 1 CRS included observation and supportive care.
- The Advanced Practice Provider (APP) played a crucial role in coordinating care and monitoring symptoms in the case study.
- A chest x-ray performed in the case study resulted in findings that were consistent with CRS-related effects, although specific details are not provided.
- An absolute neutrophil count (ANC) level of less than 500 prompted the initiation of empiric IV antibiotics in the case study.
- An additional symptom that led to consultation with the infectious disease team was a significant drop in blood pressure.
CRS Grading and Management Guidelines
- The most severe grade of CRS is Grade 4 according to the CTCAE v5.0 grading system.
- Management of Grade 2 CRS involves the use of tocilizumab along with close monitoring.
- Grade 3 CRS is marked by symptoms such as high fever, hypotension, or severe fatigue.
- If hypotension persists in Grade 2 CRS after the administration of tocilizumab and fluid boluses, vasopressors may be considered.
- For Grade 3 CRS, additional actions include potential escalation of care and consideration for ICU admission.
- Grade 4 CRS should be managed as refractory if it does not respond to initial treatments and support measures.
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Description
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.
