A 38 yo female with large B cell lymphoma who received a CAR-T cell infusion 7 days ago presenting with a temperature of 39°C, RR 26 rpm, BP 70/40, SaO2 84% on room air, that did not respond to 6 L of supplemental oxygen by nasal cannula and an intravenous bolus of crystalloid. In addition to a vasopressor and more oxygen, what grade of cytokine release syndrome is this and what antidotes should you administer?
Grade 3. Tocilizumab 8 mg/kg and dexamethasone 10 – 20 mg every 6 hours.
Lipe DM and Shafer S. CAR-T and checkpoint inhibitors: toxicities and antidotes in the emergency department. Clin Tox 2021; Ahead of print: 1-17. https://doi.org/10.1080/15563650.2021.18800088
Submitted by: Virginia Commonwealth University Medical Toxicology Fellowship