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Editorial
. 2022 Mar 1;3(2):90-94.
doi: 10.1158/2643-3230.BCD-21-0203.

Potential Role of IFNγ Inhibition in Refractory Cytokine Release Syndrome Associated with CAR T-cell Therapy

Kevin O McNerney  1   2 , Amanda M DiNofia  1   3 , David T Teachey  1   3 , Stephan A Grupp  1   3 , Shannon L Maude  1   3
Affiliations
Editorial

Potential Role of IFNγ Inhibition in Refractory Cytokine Release Syndrome Associated with CAR T-cell Therapy

Kevin O McNerney et al. Blood Cancer Discov. .

Abstract

Here we review the pathophysiology and management of cytokine release syndrome (CRS) secondary to immunotherapy, and potential options for CRS refractory to IL6 inhibition and glucocorticoids, for which there are no proven treatments. To illustrate, we describe a patient with B-cell acute lymphoblastic leukemia who developed refractory grade 4 CRS following CD19-directed chimeric antigen receptor T-cell therapy, treated with tocilizumab, methylprednisolone, siltuximab, and the IFNγ inhibitor emapalumab, with complete remission from leukemia for 12 months. See related article by Bailey et al., p. 136 (15).

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Figures

Figure 1. Clinical and laboratory features surrounding the use of emapalumab for refractory CAR T-cell–induced CRS. A, Temperature in degrees Celsius (°C). B, Ferritin in ng/mL, and CRP in mg/dL. C, Absolute neutrophil count (ANC) in cells/μL and platelets ×1,000 cells/μL. D, Fibrinogen in mg/dL and international normalized ratio (INR). E, Serum cytokine levels in pg/mL on a logarithmic scale. Expected cytokine-level elevations from previously published reports (5, 8). Asterisk (*) indicates above limit of quantification. Dagger (†) indicates below limit of quantification.
Figure 1.
Clinical and laboratory features surrounding the use of emapalumab for refractory CAR T-cell–induced CRS. A, Temperature in degrees Celsius (°C). B, Ferritin in ng/mL, and CRP in mg/dL. C, Absolute neutrophil count (ANC) in cells/μL and platelets ×1,000 cells/μL. D, Fibrinogen in mg/dL and international normalized ratio (INR). E, Serum cytokine levels in pg/mL on a logarithmic scale. Expected cytokine-level elevations from previously published reports (5, 8). Asterisk (*) indicates above limit of quantification. Dagger (†) indicates below limit of quantification.
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References

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