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. 2026 Nov 4;14(11):e016598. doi: 10.1136/jitc-2026-016598

Figure 1. Limitations of the ASTCT consensus grading system despite widespread adoption, the ASTCT system carries five unresolved limitations: redefining CRS to grade 3–4 only, grade 2 hypotension/hypoxia ambiguity, fever as an obligatory criterion, no mechanism for multiorgan dysfunction, and the status of isolated transaminitis. ASTCT, American Society for Transplantation and Cellular Therapy; CRS, cytokine release syndrome.

Diagram of five limitations of the ASTCT Consensus Grading System: Grade 2 boundary ambiguity, organ dysfunction not integrated, transaminitis inclusion, grade threshold for true CRS, and fever as obligatory criterion.