Cytokine Release Syndrome
What is a cytokine?
A cytokine is a small protein whose job is to let the body know when an immune response is needed. They play an important part in communication between cells when your body may be stressed, due to inflammation, infection, or trauma responses.
What is cytokine release syndrome?
Cytokine release syndrome (CRS) is a systemic (all of your body) inflammatory response. It can be caused by certain medications, immunotherapy treatments (CAR-T cells), infection, and illness. It is a release of cytokines into the blood from immune cells. This is a large and quick release that can happen after treatment with some types of immunotherapy, such as monoclonal antibodies and CAR-T cells. This release can overwhelm the body and the body can have a hard time adjusting.
What are the signs of cytokine release syndrome?
Signs and symptoms can range from mild to severe. The mild symptoms are:
- Generalized aches and pain.
More severe symptoms are:
- Fast heartbeat.
- Low blood pressure.
- Trouble breathing.
- Confusion, dizziness, headache, and seizures.
- Organ failure.
- Higher than normal liver and kidney levels in your blood.
- Changes in blood clotting.
The signs and symptoms of cytokine release syndrome are similar to signs and symptoms of other health issues, like neutropenic fever and sepsis. It will be very important for your providers to rule out other illnesses that are not cytokine release syndrome.
How is cytokine release syndrome managed?
If you are having any signs or symptoms of cytokine release syndrome related to your immunotherapy treatment, you will be closely monitored. You will have your vital signs checked often and lab values will be checked. Your symptoms will be managed as needed. Examples of treatments to manage symptoms include:
- IV (intravenous, into a vein) fluids.
- Medication to manage your blood pressure and heart function.
- Blood products.
You may be given medications to lower the immune response, such as corticosteroids and tocilizumab. These medications are immunosuppressive. This means they could interfere with the immunotherapy treatment you have received. Your team will carefully consider the best treatment for you before giving you these medications. If your reaction is severe enough, you may need to be treated in an intensive care unit (ICU) with a breathing tube or machines to help your heart work.
If you think you are having signs and symptoms of CRS, contact your provider right away.
Cancer.gov. Cytokine Release Syndrome. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/cytokine-release-syndrome
Mandal, A. 2019. What are cytokines? News Medical Life Sciences. https://www.news-medical.net/health/What-are-Cytokines.aspx
Riegler, L.L. et al. 2019. Current approaches in the grading and management of cytokine release syndrome after chimeric antigen receptor T-cell therapy. Therapeutics and Clinical Risk Management. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400118/
Shimabukuro-Vornhagen, A. et al. 2018. Cytokine release syndrome. Journal for immunotherapy of cancer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003181/