Standardized Toxicity Grading: Institutional Protocols for CRS and ICANS
Panelists discuss how standardized toxicity grading for cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome helps guide physicians in the timely management and escalation of care, emphasizing the importance of symptom grading and clear institutional protocols for intervention.
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.
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