Treatment of CRS is largely supportive, and early involvement of the critical care team to provide organ support where indicated is often beneficial. Patients with grade 3 and 4 CRS are at higher risk and may require vasopressors, high flow oxygen, invasive ventilation and/or renal replacement therapy.
Due to the broad potential differential at the time of presentation and the lack of specific diagnostic test, management of patients with suspected CRS must also include treatment of potential sepsis with blood cultures and antibiotics.
The European Society for Blood and Marrow Transplantation guidelines recommend use of tocilizumab, a monoclonal interleukin 6 receptor antagonist, in grades 2 to 4 CRS. Use of steroids to suppress the immune response reduces the efficacy of CAR-T therapy, but can be considered in conjunction with anakinra (an interleukin 1 receptor antagonist) and siltuximab (a monoclonal antibody targeting interleukin 6) in grade 4 CRS8.
In patients with concurrent neutropenia, granulocyte macrophage colony stimulating factor (GM-CSF) should ideally be avoided as this exacerbates CRS6.
