Standardized Toxicity Grading: Institutional Protocols for CRS and ICANS

Summary for Physicians:

Standardized Toxicity Grading: Cytokine Release Syndrome (CRS) and Immune Effector Cell–Associated Neurotoxicity Syndrome (ICANS)

• CRS:
• Grade 1: Fever, mild symptoms, manageable with supportive care

• Grade 2: Moderate symptoms (eg, hypotension, hypoxia), requires intervention (eg, intravenous fluids, antipyretics)

• Grade 3: Severe symptoms (eg, multiorgan involvement), requires corticosteroids and tocilizumab

• Grade 4: Life-threatening, requires intensive care unit (ICU) care and urgent interventions
• ICANS:
• Grade 1: Mild symptoms (eg, confusion, agitation), no intervention needed

• Grade 2: Moderate symptoms, requires steroids or other interventions

• Grade 3: Severe symptoms (eg, encephalopathy, seizures), may require ICU and immunosuppressive therapy

• Grade 4: Life-threatening, requires intensive care and urgent interventions

Institutional Protocols:

• Prompt grading of symptoms is essential for early intervention.

Clear escalation protocols for managing CRS and ICANS, with specific guidance for steroid administration, monitoring, and ICU transfer if necessary.