Haematology 2018

Immune Activation Syndrome

▪ 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:

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

Davila et al Science Transl Med 2014