. 2023 Mar 31;141(20):2430–2442. doi: 10.1182/blood.2022017414

Table 3.

Supportive care measures for patients with severe/refractory CRS or ICANS

Neurology

• Identify patients at high risk of developing ICANS and engage neurology early¹¹³

• Tailor duration of steroids in patients with severe ICANS to treat toxicity but limit adverse side effects

Immune/hematologic

• Limit the duration of high-dose steroids for the management of toxicity to diminish immune suppression

• Use cytokine-directed treatments, such as anakinra, as a steroid-sparing approach²⁰^,⁴³^,⁵⁷

• Optimize approaches to treat ongoing cytopenias

Infectious disease

• Use prophylactic antimicrobials, such as trimethoprim-sulfamethoxazole, for Pneumocystis jirovecii prophylaxis²²

• Use prophylactic antivirals, such as acyclovir or valacyclovir, for herpes virus prophylaxis before conditioning chemotherapy²²

• Practice antibiotic stewardship with broad-spectrum antibiotics and blood cultures for patients with neutropenic fever¹¹⁴^,¹¹⁵

• Assess for CMV, adeno- or other viremias in patients with persistent cytopenia after treatment

• Optimize antifungal prophylaxis in patients with prolonged immunosuppression due to CRS/ICANS management and cytopenias

Rehabilitation

• Involve inpatient rehabilitation services for patients, particularly those with lengthy hospital stays or those who received prolonged steroids, after they are clinically stable

• Encourage engagement of caregivers and social workers

Cognitive/psychosocial

• Consult psychiatry or psychiatric oncology to aid in the management of delirium, particularly in older or pediatric patients who develop ICANS