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J Immunother Cancer. 2018 Jun 15;6(1):56. doi: 10.1186/s40425-018-0343-9.

Cytokine release syndrome.

Author information

1
Cologne Interventional Immunology, University Hospital of Cologne, Cologne, Germany. shima@uk-koeln.de.
2
Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany. shima@uk-koeln.de.
3
Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany. shima@uk-koeln.de.
4
Intensive Care in Hemato-Oncologic Patients (iCHOP), Cologne, Germany. shima@uk-koeln.de.
5
Cologne Interventional Immunology, University Hospital of Cologne, Cologne, Germany.
6
Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
7
Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany.
8
Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.
9
Translational Cancer Immunology, Gene Centre, University of Munich, Munich, Germany.
10
German Cancer Consortium (DKTK), Heidelberg, Germany.
11
Comprehensive Cancer Center Munich (CCCM), Munich, Germany.
12
Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany.
13
Department of Dermatology/Venereology, University Hospital of Cologne, Cologne, Germany.
14
Intensive Care in Hemato-Oncologic Patients (iCHOP), Cologne, Germany.

Abstract

During the last decade the field of cancer immunotherapy has witnessed impressive progress. Highly effective immunotherapies such as immune checkpoint inhibition, and T-cell engaging therapies like bispecific T-cell engaging (BiTE) single-chain antibody constructs and chimeric antigen receptor (CAR) T cells have shown remarkable efficacy in clinical trials and some of these agents have already received regulatory approval. However, along with growing experience in the clinical application of these potent immunotherapeutic agents comes the increasing awareness of their inherent and potentially fatal adverse effects, most notably the cytokine release syndrome (CRS). This review provides a comprehensive overview of the mechanisms underlying CRS pathophysiology, risk factors, clinical presentation, differential diagnoses, and prognostic factors. In addition, based on the current evidence we give practical guidance to the management of the cytokine release syndrome.

KEYWORDS:

CAR T cells; Cytokine release syndrome; Cytokine storm; Immunotherapy; T cell-engaging therapies

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