Table 3. Management of Cytokine Release Syndrome.

Grade	Presenting symptoms	Actions
Grade 1	Temperature ≥ 38°C (100.4°F) attributed to CRS	Withhold teclistamab-cqyv until CRS resolves. Administer premedication prior to the next teclistamab-cqyv dose.
Grade 2	Temperature ≥ 38°C (100.4°F) attributed to CRS, with: hypotension responsive to fluids and not requiring vasopressors and/or oxygen requirement of low-flow nasal cannula (≤ 6 L/minute) or blow-by	Withhold teclistamab-cqyv until CRS resolves. Administer premedication prior to the next dose. Patients should be hospitalized for 48 hours following the next teclistamab-cqyv dose.
Grade 3	Temperature ≥ 38°C (100.4°F) attributed to CRS, with: hypotension requiring one vasopressor with or without vasopressin and/or oxygen requirement of high-flow nasal cannula (> 6 L/minute), face mask, nonrebreather mask, or Venturi mask	First occurrence of grade 3 CRS with duration < 48 hours: Withhold teclistamab-cqyv until CRS resolves. Provide supportive therapy as clinically necessary (may include intensive care). Administer premedication prior to the next teclistamab-cqyv dose. Patients should be hospitalized for 48 hours following the next teclistamab-cqyv dose. Recurrent grade 3 CRS or grade 3 CRS with duration ≥ 48 hours: Permanently discontinue teclistamab-cqyv. Provide supportive care as clinically necessary (may include intensive care).
Grade 4	Temperature ≥ 38°C (100.4°F) attributed to CRS, with: hypotension requiring multiple vasopressors (excluding vasopressin) and/or oxygen requirement of positive pressure (e.g., CPAP, BiPAP, intubation, and mechanical ventilation)	Permanently discontinue teclistamab-cqyv. Provide supportive care as clinically necessary (may include intensive care).

Note. CPAP = continuous positive airway pressure; BiPAP = bilevel positive airway pressure. Information from Janssen Biotech, Inc. (2022).