Researchers conducted a systematic review of data on cytokine release syndrome (CRS) in pediatric patients with certain B-cell malignancies who were treated with either chimeric antigen receptor T-cell (CAR-T) therapy or blinatumomab. The researchers also provided recommendations based on their research. Their findings were published in the Journal of Pediatric Oncology Nursing.

“CRS is a frequent and potentially life-threatening consequence of T-cell-engaging immunotherapies, yet recommendations for nursing practice are often based on single-institution experiences or are lacking altogether,” explained the researchers. Their goal was to identify recommendations for pediatric oncology nurses involved in the care of patients with B-precursor acute lymphoblastic leukemia (B-ALL) and B-cell lymphoma who may develop CRS following receipt of CAR-T therapy or blinatumomab.

In this review, the researchers identified 6 studies and 1 clinical practice guideline addressing the topic of CRS in pediatric patients treated with these approaches. Five of the studies involved CAR-T therapy and 1 involved blinatumomab, with 5 studies based in the US and 1 based in China. Although all studies included pediatric patients, some also included adults. The clinical practice guideline was a publication of the CAR-T-cell-therapy-associated TOXicity (CARTOX) Working Group.

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A total of 6 nursing practice recommendations were identified through this analysis. Five were considered strong recommendations and 1 was considered weak. All were based on what was considered low-quality or very low-quality evidence.

Three strong recommendations regarded preinfusion monitoring: to recognize that patients with higher disease burden were at higher risk of developing CRS and greater severity of CRS; to recognize the time period during which risk of developing CRS is highest; and to closely monitor vital signs during and after infusion in patients who are either febrile or at increased risk of severe CRS.

Two strong recommendations regarded nurses’ role in CRS management: to anticipate a need to rapidly escalate care in patients with CRS; and to anticipate the need for tocilizumab or similar agents to manage CRS symptoms.

One recommendation, considered weak, was to clarify orders for corticosteroids in patients with CRS treated with CAR-T therapy.

“Nurses are well positioned to play a critical role in monitoring for signs and symptoms of CRS and ensuring that appropriate management strategies are utilized,” the researchers concluded, although more research on identifying CRS risk and its management are needed.


Browne EK, Daut E, Hente M, Turner K, Waters K, Duffy EA. Evidence-based recommendations for nurse monitoring and management of immunotherapy-induced cytokine release syndrome: a systematic review from the Children’s Oncology Group. J Pediatr Oncol Nurs. Published online August 30, 2021. doi:10.1177/10434542211040203