Figure 4.

Chimeric antigen receptor (CAR) T cell infusion–mediated toxicity. CAR T cells are infused and then interact with cancer cells, where they expand further and release IFN-γ and TNF-α. These stimulate macrophage activation. CAR T cells also cause lysis of cancer cells, which leads to release of cytokines and activation of macrophages and dendritic cells. IL-1, IL-6, and IL-8 are released as well as TNF-α and monocyte chemo-attractant 1 (MCP1). IL-6 is the most significant cytokine in the cytokine release syndrome. AKI and electrolyte abnormalities may occur in this setting. Tocilizumab blocks IL-6 from binding to its receptor, reducing the effects of cytokine release syndrome (CRS). APC, antigen-presenting cell.