Therapeutic agents associated with the CRS:
(1) OKT3 (targets CD3)
(2) BL22 (targets CD22)
(3) recombinant IL-2
Purported mechanism: increased production and release of cytokines from T cells, including tumor necrosis factor (TNF), interferon, and the interleukins. TNF-alpha is believed to be the primary mediator for CRS.
Clinical features of the CRS:
(1) flu-like syndrome with fever, myalgias, arthralgias, lightheadedness, nasal congestion, and chills
(2) unexplained fatigue
(3) gastrointestinal symptoms (anorexia, nausea, vomiting, severe diarrhea)
(4) neurologic symptoms (headache, aseptic meningitis, seizures, encephalopathy
(5) hypercoagulability
(6) nephropathy
(7) acute pulmonary edema secondary to capillary leak
(8) blood pressure changes (hypotension or hypertension)
(9) leukopenia
Several of the cytokines can be measured in serum.
Diagnosis:
(1) exposure to a therapeutic agents known to increase release of cytokines
(2) presence of symptoms corresponding to increased cytokine levels in the serum
