Cancer treatments which stimulate the immune system can trigger an excessive and rapid release of cytokines into the blood stream. This can result in cytokine release syndrome (CRS). CRS is an acute systemic inflammatory response, characterised by fever and in severe events can lead to multiple organ dysfunction.
Severity of CRS ranges from mild to life-threatening, and when severe, is considered an oncological emergency.
By the end of this rapid learning you will be able to:
- Describe the signs and symptoms of CRS
- Detail the assessment and immediate nursing interventions for CRS
- Outline the investigations that may be undertaken in the diagnostic work-up for CRS
- Identify management options for CRS
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Case study podcast
This Rapid Learning edition we hear from Nicola Mason, Paediatric Fellow at Westmead Children's Hospital, who shares a unique clinical case study of caring for a patient with cytokine release syndrome.
Download the eviQ Education app to access exclusive content, including the CRS mini quiz and eight other oncological emergency interactive lessons.
Use the QR code to access to CRS mini quiz, or visit our mini quizzes homepage for more information.
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eviQ clinical resources
- D. L. Porter, R. S. Negrin and A. G. Rosmarin, "Cytokine Release Syndrome," 18 December 2020. [Online]. Available: www.uptodate.com.acs.hcn.com.au
- Ceschi, R. Noseda, K. Palin and K. Verhamme, "Immune Checkpoint Inhibitor-Related Cytokine Release Syndrome: Analysis of WHO Global Pharmacovigilance Database," Frontiers in Pharmacology, vol. 11, no. 557, 2020.
- M. Norelli, B. Camisa, G. Barbiera, L. Falcone, A. Purevdorj, M. Genua, F. Sanvito, M. Ponzoni, C. Doglioni, P. Cristofori, C. Traversari, C. Bordignon, F. Ciceri, R. Ostuni, C. Bonini, M. Casucci and A. Bondanza, "Monocyte-derived IL-1 and IL-6 are differentially required for cytokine-release syndrome and neurotoxicity due to CAR T cells," Nature Medicine, vol. 24, no. 6, pp. 739-748, 2018.
- Shimabukuro-Vornhagen, P. Godel, M. Subklewe, H. J. Stemmler, H. A. SchloBer, M. Schlaak, M. Kochanek, B. Boll and M. S. von Bergwelt-Baildon, "Cytokine Release Syndrome," Journal for ImmunoTherapy of Cancer, vol. 6, no. 56, 2018. CC 4.0: https://creativecommons.org/licenses/by/4.0/.
- Gutierrez, C. McEvoy, L. Munshi, R. S. Stephens, M. E. Detsky, J. L. Nates and S. M. Pastores, "Critical Care Management of Toxicities," Society of Critical Care Medicine, vol. 48, no. 1, 2020.
- K. K. Gupta, M. A. Khan and S. K. SIngh, "Constitutive Inflammatory Cytokine Storm: A Major Threat to Human Health," JOURNAL OF INTERFERON & CYTOKINE RESEARCH, vol. 40, no. 1, pp. 19-23, 2020.
- B. Asselin, "Immunology of infusion reactions in the treatment of patients with acute lymphoblastic leukemia," Future Oncology, vol. 12, no. 13, 2016.
- Lee, D. W., B. D. Santomasso, F. L. Locke, et al. 2019. "ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells." Biol Blood Marrow Transplant 25(4):625-638.
- National Institute of Health & National Cancer Institute, "Common Terminology Criteria for Adverse Events (CTCAE) v5.0," 27 November 2017. [Online]. Available: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm
- NCCN Clinical Practice Guidelines in Oncology - Management of Immunotherapy-Related Toxicities - Version 1.2020
- St Jude Children's Research Hospital, "St Jude Children's Research Hospital," 03 2019. [Online]. Available: https://together.stjude.org/en-us/diagnosis-treatment/side-effects/cytokine-release-syndrome-crs.html.
- J. Kaur, S. Horner, L. Osburg, S. Muller, M. Marklin, J. S. Heitmann, L. Zekri, H. G. Rammensee, H. Salih and G. Jung, "Tocilizumab, but not dexamethasone prevents CRS without affecting antitumour activity of bispecific antibodies," Journal for ImmunoTherapy of Cancer, vol. 8, no. 1, 2020.