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Cytokine Release Syndrome

🩺 Nursing & Health By CampusDown Wiki Editorial Team Last updated
Quick answer: cytokine release syndrome occurs when strongly activated immune cells such as T cells release large amounts of cytokines at once, causing high fever, low blood pressure, low oxygen and other systemic effects. It most often follows immunotherapies such as CAR-T cells.
Contents
  1. 1. Causes
  2. 2. Mechanism
  3. 3. Symptoms and grading
  4. 4. Treatment
  5. 5. References

Causes

  • CAR-T cell therapy: the most common cause in blood cancer treatment, usually starting within days of infusion.
  • Bispecific T-cell engagers such as blinatumomab
  • Some monoclonal antibodies: in the 2006 TGN1412 trial six healthy volunteers developed severe CRS.
  • Infections such as severe COVID-19 and stem cell transplantation can cause similar hyperinflammation.

Mechanism

T cells recognizing their target release IFN-γ and other mediators, which activate macrophages and endothelial cells to release large amounts of IL-6 and IL-1. Vascular leak causes hypotension, edema and organ dysfunction. CRS is one form of the broader "cytokine storm".

Symptoms and grading

Fever (≥38°C) is required; the American Society for Transplantation and Cellular Therapy (ASTCT) consensus grades CRS 1-4 by hypotension and hypoxia, from fever alone (grade 1) to needing multiple vasopressors or positive-pressure ventilation (grade 4). Neurotoxicity (ICANS) is graded separately.

Treatment

  • Mild: antipyretics, fluids, supportive care
  • Moderate or worse: the IL-6 receptor blocker tocilizumab (FDA-approved for CAR-T-related CRS in 2017), corticosteroids if needed
  • Severe: intensive care, vasopressors, oxygen support

This is general information; diagnosis and treatment should follow the care team's judgment.

References

  1. Lee, D. W., Santomasso, B. D., Locke, F. L., et al. (2019). ASTCT consensus grading for cytokine release syndrome and neurologic toxicity associated with immune effector cells. Biology of Blood and Marrow Transplantation, 25(4), 625-638.
  2. Shimabukuro-Vornhagen, A., Gödel, P., Subklewe, M., et al. (2018). Cytokine release syndrome. Journal for ImmunoTherapy of Cancer, 6, 56.
  3. Suntharalingam, G., Perry, M. R., Ward, S., et al. (2006). Cytokine storm in a phase 1 trial of the anti-CD28 monoclonal antibody TGN1412. New England Journal of Medicine, 355(10), 1018-1028.
  4. Le, R. Q., Li, L., Yuan, W., et al. (2018). FDA approval summary: Tocilizumab for treatment of chimeric antigen receptor T cell-induced severe or life-threatening cytokine release syndrome. The Oncologist, 23(8), 943-947.

Reports and materials that use this theory (Korean)

There are no materials dedicated to this theory yet, but you can search related reports in the CampusDown library (Korean).

Find more reports · Search '시토카인 방출 증후군' on CampusDown →
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This article was last updated on October 15, 2026. It is based on widely recognized original works and textbooks; when citing it in a paper, please check the original sources listed in the references.