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▪ Fever/myalgia→ MOF with hypoxia/hypotension. Resembles HLH
▪ Associates with ↑ IL-6, IFN-γ, IL-10
▪ Severity may correlate with tumour burden
▪ ↑CRP + fever > 3 days predictive of those requiring Rx
▪ Proposed diagnostic criteria for severe Immune activation syndrome:
Davila et al Science Transl Med 2014
Immune Activation Syndrome
Fever for over 3 days
Maximal elevation of serum cytokines
One of the following clinical manifestations:
▪ Hypotension requiring vasporessor therapy
▪ Hypoxia with sat O2 <90%
▪ Neurological disturbance including delirium, obtundation, seizures
Treatment
▪short course steroids – may compromise persistence of CAR T cells
▪IL-6R antagonism via tocilizumab