Table 2.
ASTCT Consensus Grading for Cytokine Release Syndrome
| Grade 1 | Grade 2 | Grade 3 | Grade 4 | |
|---|---|---|---|---|
| Fever Temperature ≥38°C With or without constitutional symptoms (which include myalgia, arthralgia, and malaise) |
+ | + | + | + |
| With | ||||
| Hypotension | – | + No vasopressors required |
+ Requiring one vasopressor without vasopressin |
+ Requiring multiple vasopressors (excluding vasopressin) |
| And/or | ||||
| Hypoxia | – | + Requiring low-flow nasal cannula or blow-by |
+ Requiring high-flow nasal cannula, facemask, nonrebreather mask, or Venturi mask |
+ Requiring positive pressure (i.e., CPAP, BiPAP, intubation, mechanical ventilation) |
The assessment and grading of cytokine release syndrome has not been uniform, particularly early on in the experience with CAR T-cell therapy. Subsequently, this has prompted a consensus approach to grading the severity of cytokine release syndrome, which was released by the American Society for Transplantation and Cellular Therapy (ASTCT) in 2019.
BiPAP = bilevel positive airway pressure; CPAP = continuous positive airway pressure.