Recommendations for the timing, dosage, and usage of corticosteroids during cytokine release syndrome (CRS) caused by chimeric antigen receptor (CAR)-T cell therapy for hematologic malignancies

作者：Sanfang Tu, Xiu Luo, Heng Mei, Yongxian Hu, Yang Liu, Ping Li, Dehui Zou, Ting Niu, Kailin Xu, Xi Zhang, Lugui Qiu, Lei Gao, Guangxun Gao, Li Zhang, Yimei Feng, Ying Wang, Mingfeng Zhao, Jian‐Qing Mi, Ming Hou, Jianmin Yang, He Huang, Jianxiang Wang, Yu Hu, Weili Zhao, Depei Wu, Jun Ma, Yuhua Li, Wenbin Qian, Xiao‐Jun Huang, Weidong Han, Aibin Liang · 发表于：Chinese Medical Journal · 年份：2024 · DOI：10.1097/cm9.0000000000003379 · 被引用次数：5 · 研究领域：CAR-T cell therapy research

Clinical question What are the recommendations for the timing, dosage, and usage of corticosteroids during cytokine release syndrome (CRS) caused by chimeric antigen receptor (CAR)-T cell therapy for hematologic malignancies? Recommendations The administration of corticosteroids in CRS should be managed depending on the risk stratification and grading of CRS occurrence, combined with clinical situation, dynamic assessments of CAR-T cell kinetics and cytokine level changes [Table 1]. Table 1 - Recommendations for the management of CRS with corticosteroids in the patients receiving CAR-T therapy. CRS Grades Standard-risk patients High-risk patients Grade 1 Administration of corticosteroids is not recommended. Dexamethasone 5–10 mg for one dose for persistent fever lasting after interventions including antipyretics, IL-6 receptor /IL-6 antagonists, or hydration.The corticosteroid administration should be repeated If there is no improvement within 24 hours. Grade 2 Dexamethasone 5–10 mg for one dose in combination with IL-6 receptor/IL-6 antagonists. Reassess every 12 hours and repeat dexamethasone 10 mg for one dose if if there is no improvement. Dexamethasone 10 mg for one dose simultaneously with IL-6 receptor/IL-6 antagonists. Reassess every 6 hours and repeat dexamethasone 10 mg for one dose if there is no improvement. Grade 3 Administer dexamethasone 10 mg i.v. every 6 hours. If there is no improvement within 24 hours, increase dexamethasone to 20 mg i.v. every 6 hours for ...