Patient selection: relapsed or refractory malignant lymphoma (excluding mantle cell lymphoma) treated with CART therapy
Neurotoxicity: encephalopathy, aphasia, cerebral edema
Parameters:
(1) age in years
(2) histologic subtype
(3) maximum body temperature in °C
(4) maximum serum C-reactive protein in mg/dL
(5) maximum serum ferritin in ng/mL
(6) minimum WBC counter per microliter
(7) grade of cytokine release syndrome (CRS) severity (from 0 to 4)
(8) day of cytokine release syndrome onset
(9) number of doses of toclizumab (anti-interleukin 6R monoclonal antibody) received by day 5 (used in the treatment of cytokine release syndrome
|
Parameter
|
Finding
|
Points
|
|
age
|
< 52 years
|
0
|
|
|
>= 52 years
|
1
|
|
histologic subtype
|
indolent
|
0
|
|
|
aggressive
|
2
|
|
max temperature
|
< 38.5
|
0
|
|
|
>= 38.5
|
2
|
|
max CRP
|
< 8.95 mg/dL
|
0
|
|
|
>= 8.95 mg/dL
|
1
|
|
max ferritin
|
< 641 ng/mL
|
0
|
|
|
>= 641 ng/mL
|
1
|
|
min WBC count
|
> 790 per µL
|
0
|
|
|
<= 790 per µL
|
1
|
|
CRS severity
|
Grade 0
|
0
|
|
|
Grade 1 or higher
|
2
|
|
day of CRS onset
|
>= 3 days
|
0
|
|
|
< 3 days
|
1
|
|
doses of tocilizumab
|
0
|
0
|
|
|
>= 1
|
3
|
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 14
• The higher the score the greater the risk of neurotoxicity.
• A score >= 6 is associated with Grade 2 or higher neurotoxicity.
Performance:
• The area under the ROC curve is 0.74.
