ASTCT 2019 — ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells
ASTCT, 2019
Tocilizumab (8 mg/kg IV) is recommended as first-line targeted therapy for Grade >= 2 Cytokine Release Syndrome (CRS). Corticosteroids (dexamethasone or methylprednisolone) are first-line therapy for Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS); tocilizumab is not indicated for isolated ICANS without CRS.
Clinical Context & Relevant Topics (3)
Disease ReferenceHost immune defects, neutropenic sepsis, acute respiratory failure (PJP/Aspergillus), tumor lysis syndrome, leukostasis, CAR-T CRS/ICANS, and ICU triage.
Life-threatening organ dysfunction caused by a dysregulated host response to infection — recognized by an acute rise in SOFA score, not by infection plus fever alone.
Monro-Kellie doctrine, ICP waveforms (P2>P1, Lundberg A-waves), CPP targets (60–70 mmHg), herniation syndromes, and the 4-tier BTF management protocol.