CRS, ICANS management

소개글

CRS, ICANS management에 대한 보고서 자료입니다.

본문내용

Cytokine releasing syndrome (CRS)

“A supraphysiologic response following any immune therapy that results in the activation or engagement of endogenous or infused T cells and/or other immune effector cells”
Overactivation of immune effector cells leads to the release of inflammatory cytokines (IL-6, IL-1, IFN-gamma, TNF-alpha, etc) resulting in endothelial injury and capillary leak, leading to hemodynamic instability and organ dysfunctions.
Fever, hypotension, tachycardia, hypoxia, chills, cardiac, hepatic, renal dysfunction, atrial fibrillation, ventricular tachycardia, cardiac arrest, cardiac failure, capillary leak syndrome(pleural effusion, pulmonary edema 등)
Post-infusion 2-3일 이내로 발생하여 7-8일 지속. 10-15일까지도 지속 가능
치료의 근간은 tocilizumab (anti-IL6R mAb), corticosteroids
Grading 기준은 shock ± vasopressor(s), O2 요구량(<6L/>6L/intubation), response to tocilizumab
Tisa-cell의 경우 CRS 발생한 69% case (31/45) 에서 1st tocilizumab dose 투여 2주 이내 CRS가 호전됨
Tocilizumab, steroid에 refractory한 경우 anakinra, siltuximab, ruxolitinib, cyclophosphamide, IVIG, ATG, CRRT 등 고려 (근거는 제한적)

키워드

ICANS,   CRS,   사이토카인방출증후군,   cart치료,   cart부작용