Severe cytokine release syndrome induced by immune checkpoint inhibitors in cancer patients - A case report and review of the literature

Yujing Zhang; Xiaoyue Wen; Yaqi OuYang; Yingying Hu; Xiangzhi Fang; Jiancheng Zhang; Yin Yuan

doi:10.1016/j.heliyon.2024.e24380

Severe cytokine release syndrome induced by immune checkpoint inhibitors in cancer patients - A case report and review of the literature

Heliyon. 2024 Jan 10;10(2):e24380. doi: 10.1016/j.heliyon.2024.e24380. eCollection 2024 Jan 30.

Authors

Yujing Zhang^{1

2}, Xiaoyue Wen^{1

2}, Yaqi OuYang^{1

2}, Yingying Hu^{1

2}, Xiangzhi Fang^{1

2}, Jiancheng Zhang^{1

2}, Yin Yuan^{1

2}

Affiliations

¹ Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, PR China.
² Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, PR China.

Abstract

Cytokine release syndrome (CRS) can be induced by immune checkpoint inhibitors (ICIs). Although the incidence of CRS is low, it is often underreported. Here, we report two severe CRS cases and summarize and review 51 patients with ICI-induced CRS to explore the possible contributing factors to the disease prognosis and provide assistance for therapy. Our analysis found that the population with ICI-induced CRS consists mainly of male patients with an average age of 61.74 years. The primary malignant tumor type was lung cancer, and the clinical stage of most patients was stage IV. Notably, patients who experience a longer time to CRS onset, higher IL-6 levels, and lower platelet counts may be more likely to develop severe CRS. Cardiovascular, respiratory, neurological, and coagulation toxicities are more common in higher-grade CRS and may serve as markers for patient experiencing ICU admission, oxygen supplementation, hypotension, high-dose vasopressors usage, and intubation.

Keywords: Case report; Cytokine release syndrome; Immune checkpoint inhibitor; Immune-related adverse event; Immunotherapy.

Publication types

Case Reports