Table 2.

ASTCT Criteria for Grading CRS and ICANS. Adapted from Lee et al.⁸⁶

Toxicity	Parameter	Grade 1	Grade 2	Grade 3	Grade 4
CRS	Fever	Temp ≥38°C	Temp ≥38°C	Temp ≥38°C	Temp ≥38°C
			And
	Hypotension	None	No pressor requirement	Pressor requirement with or without vasopressin	Multiple pressors excluding vasopressin
			And/or
	Hypoxia	None	Requiring O2 by low-flow NC (≤6 L/min) or blow-by	Requiring O2 by HFNC, facemask, nonrebreather mask or Venturi mask	Requiring positive pressure ventilatory support*
ICANS	ICE score†	7–9	3–6	0–2	0
	Depressed consciousness not attributable to other cause	Awakens spontaneously	Awakens to voice	Awakens only to tactile stimulus	Arousable with vigorous tactile stimuli, unarousable, stupor, or coma
	Seizures	NA	NA	Any seizure with rapid clinical resolution or with intervention on EEG tracings	Prolonged (>5 min), non-resolving or life-threatening seizures
	Motor findings	NA	NA	NA	Significant focal motor weakness (eg, hemiparesis or paraparesis)
	Elevated ICP/cerebral edema‡	NA	NA	Focal edema on brain imaging	Diffuse edema on imaging, or decerebrate/decorticate posturing, CN VI palsy, or Cushing’s triad

Notes: *Positive pressure ventilation includes continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP) or mechanical ventilation. ^†Immune Effector Cell-Associated Encephalopathy (ICE) score includes points for orientation (year, month, city, hospital; 4 points), naming (three objects; 3 points); following simple commands (1 point), writing a simple sentence (1 point), and attention (eg, counting backwards from 100 by 10; 1 point). ^‡Excludes intracranial hemorrhage or associated edema.

Abbreviations: Temp, temperature; NC, nasal cannula; O₂, supplemental oxygen; HFNC, high-flow nasal cannula (>6 L/min); NA, not applicable; EEG, electroencephalogram; CN, cranial nerve; CRS, cytokine release syndrome; ICANS, immune effector cell-associated neurotoxicity syndrome.