CRS, ICANS 문헌고찰, 진단기준, 치료법

소개

세브란스 본원에서 연구하고 교육되며 실제 사례에 적용되는 자료를 바탕으로 작성되었습니다.

목차

1. Cytokine releasing syndrome (CRS)
2. Immune effector cell-associated neurotoxicity syndrome (ICANS)
3. CAR-T 후 CRS, ICANS 모니터링 방법 (* grade 별 증상, 간호 및 치료법)
4. management 방법

본문내용

1. Cytokine releasing syndrome (CRS)
“A supraphysiologic response following any immune therapy that results in the activation or engagement of endogenous or infused T cells and/or other immune effector cells”
.Overactivation of immune effector cells leads to the release of inflammatory cytokines (IL-6, IL-1, IFN-gamma, TNF-alpha, etc) resulting in endothelial injury and capillary leak, leading to hemodynamic instability and organ dysfunctions.
.Fever, hypotension, tachycardia, hypoxia, chills, cardiac, hepatic, renal dysfunction, atrial fibrillation, ventricular tachycardia, cardiac arrest, cardiac failure, capillary leak syndrome(pleural effusion, pulmonary edema 등)
.Post-infusion 2-3일 이내로 발생하여 7-8일 지속. 10-15일까지도 지속 가능
.치료의 근간은 tocilizumab (anti-IL6R mAb), corticosteroids
.Grading 기준은 shock ± vasopressor(s), O2 요구량(<6L/>6L/intubation), response to tocilizumab

참고자료

· NCCN Guidelines Version 1. 2022. Management of CAR T-Cell-Related Toxicities.