44-Cytokine Release Syndrome in Chimeric Antigen Receptor T-Cell Therapy: The CAR-ICU Experience
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Immunology, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Heather P. May

Methods: Multicenter historical cohort study of adults receiving CART who were admitted to the ICU with CRS from November 2017 to May 2019 in 7 US centers from the CAR-ICU initiative. Descriptive statistics were used to report demographic data and characteristics of CRS and ICU management, with continuous data reported as median (IQR).

Results: 111 patients required ICU admission during the study timeframe. CRS was the primary reason for ICU admission in 46 (41%) and 85 (77%) experienced CRS at some point during ICU stay. Overlapping CRS and immune effector cell-associated neurotoxicity syndrome was present in 66 (60%). Most had lymphoma (99%) and age was 59(18-84). SOFA score on ICU admission and maximum SOFA score during ICU stay was 4(1-21) and 6(1-23), respectively. Lee (64%), Neelapu (23%) and ASTCT (11%) criteria were used for CRS grading. Number of days from CART infusion to maximum grade CRS was 5(0-55) and from infusion to ICU admission was 5(0-54). Hypotension was present in 45 (53%) patients and 20 (24%) required vasopressors (CRS grade 3-4) for 1(1-4) day. Only 1 vasopressor was required in 16 (80%) cases. Hypoxia was present in 26 (31%) and 8 (9%) required high-flow nasal cannula, 8 (9%) BiPAP, and 3 (4%) mechanical ventilation (CRS grade 3-4). Other organ toxicities observed included arrhythmias (24%), cardiomyopathy (4%), non-cardiogenic pulmonary edema (15%) and liver injury (31%). Kidney injury was present in 11 (13%) patients and 2 required dialysis. Treatment for CRS included tocilizumab (80%), siltuximab (4%), corticosteroids (35%) and anakinra (1%). ICU and hospital LOS in patients with CRS was 1(1-21) and 23(5-80) days, respectively. Eight patients (9.4%) died in the ICU with 1 death attributed to CRS. Median overall survival was 10 months for patients with CRS.

Conclusions: One-third of patients in the ICU following CART experienced grades 3-4 CRS and treatment predominantly consisted of interleukin-6 inhibitors and corticosteroids. Other organ toxicities included arrhythmia, liver injury, kidney injury and pulmonary edema. ICU mortality remains low despite a high prevalence of CRS among critically ill patients.

Meta Tag
Content Type Presentation
Knowledge Area Immunology
Knowledge Level Advanced
Membership Level Select
Tag Oncology
Year 2021
Heather May
cytokine release syndrome
chimeric antigen receptor T-cell therapy


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