Immunotherapy can help your body fight cancer. This development in cancer treatment has helped improve cancer treatment outlook in recent years.
However, sometimes immunotherapy treatments can cause your immune system to overreact. This is called cytokine release syndrome, and it can lead to inflammation and toxicity throughout the body.
Some cases of cytokine release syndrome are mild and easily treated, but others can be fatal. Treatment depends on the severity. It often includes immunosuppressive medications and oxygen support.
This article will provide you with information about what causes cytokine release syndrome and how you can recognize the symptoms, as well as which types of treatment might be best for you, depending on the severity of your situation and whether you can take immunosuppressive medications.
Cytokine release syndrome is a set of symptoms that can develop as a side effect of immunotherapy treatment or as a response to infection.
Many early hospitalizations for severe COVID-19 were complicated by cytokine release syndrome, according to a June 2020 study.
Cytokines are a type of messenger protein that helps direct immune responses. Very high levels of cytokines can cause the immune system to kick in throughout the entire body, resulting in inflammation and a wide range of symptoms.
Many cases of cytokine release syndrome are mild and cause symptoms such as fever and nausea. However, in severe cases, cytokine response syndrome can lead to possible organ failure and even death.
Cytokines are important for your immune system. They tell your immune system how to respond to possible threats and help control the action and growth of immune and blood cells.
Cytokine release syndrome can occur when immunotherapy causes too many cytokines to be released throughout the body. It can also happen when your body is responding to infection and makes too much cytokine.
High levels of cytokines in the bloodstream can cause the immune system to go into overdrive, which can cause inflammation throughout the body.
Certain types of immunotherapy increase the risk of cytokine release syndrome:
- Blinatumomab: Children receiving blinatumomab (Blincyto) monoclonal antibody treatment have an increased risk.
- Ttisagenlecleucel: Children receiving tisagenlecleucel (Kymriah) CAR T-cell immunotherapy are at a higher risk.
- Rituximab: The risk is higher for people of all ages receiving rituximab (Rituxan) monoclonal antibody treatment.
Additionally, some groups undergoing immunotherapy are at higher risk. These include people who:
- are ages 65 and over
- live in group living or nursing care facilities
- live with any type of diabetes
- have heart disease
- have any underlying health conditions that affect the immune system
- have obesity
Doctors group cases of cytokine release syndrome into stages based on the severity of symptoms.
There are four cytokine release syndrome stages, or grades. Higher stages are for more serious symptoms. Factors that are used to determine staging include:
- severity of symptoms
- blood pressure, heart rate, respiration rate, and other vital signs
- number of medical interventions needed
- a person’s ability to breathe on their own
- presence of organ toxicity or damage
Not every medical facility uses the exact same stages or grading guidelines. However, general stages are broken down as:
- Stage 1: This stage causes mild symptoms that respond to treatment.
- Stage 2: In this stage, people experience moderate symptoms that require treatment. Organ toxicity is present, and supplemental oxygen might be needed.
- Stage 3: In this stage, severe symptoms that require aggressive treatment occur. Organ toxicity is present, supplemental oxygen is needed, and blood pressure is very low.
- Stage 4: This stage causes life threatening symptoms. People in stage 4 might require a ventilator and will have significant organ toxicity.
The symptoms of cytokine release syndrome vary depending on the stage and on the organ systems affected. Some people will experience mild symptoms. Other cases of cytokine release syndrome can be fatal.
Genera symptoms of cytokine release syndrome include:
- loss of appetite
- muscle pain
- joint pain
- skin rash
If cytokine release syndrome progresses to later stages, symptoms might include:
- low blood pressure
- rapid heart rate
- swelling in the legs and feet
- difficulty communicating
- loss of coordination and fine motor skills
- chronic cough
- shortness of breath
- decreased blood oxygen level
Cytokine release syndrome isn’t always a side effect of immunotherapy. It can also be caused by infections. This means that although immunotherapy greatly increases the risk, people who’ve never received immunotherapy can also develop cytokine release syndrome. It’s not possible to 100% prevent this syndrome.
However, reducing your dose of immunotherapy medication can lower your risk.
Consult your doctor about immunotherapy and your individual risks. They can prescribe the specific dosage or specific type of immunotherapy treatment that carries the lowest risk for you.
Treatment of cytokine release syndrome varies depending on the stages and symptoms. Mild cases in the early stages will have a very different treatment course than severe, late-stage cases.
Additionally, the overall health of the person and the current status of their cancer treatment can play a role in how cytokine release syndrome is treated.
Treatment might include:
- Monitoring: People who are at risk for cytokine release syndrome are often monitored for symptoms that could signal the condition. This typically includes treatment with immunosuppressant medications to prevent cytokine release syndrome and lab testing to watch for rising cytokine levels.
- Symptom management: Treatment for cytokine release syndrome typically involves treating symptoms. This might involve medications to help support your heart function, regulate your blood pressure, manage pain, and prevent seizures.
- Oxygen support: Many people experiencing cytokine release syndrome are treated with supplemental oxygen. In severe cases, a ventilator might be needed.
- Blood transfusions: Blood transfusions can help improve symptoms and increase blood oxygen levels.
- Immune-system suppression: Severe cytokine release syndrome is treated with corticosteroids and other immunosuppressive medications, including medications, such as tocilizumab and siltuximab, that block cytokine release.
Cytokine release syndrome is an immune system overresponse that can occur as the result of immunotherapy or infection. It happens when an immune system communication protein called cytokine is overproduced. This leads to inflammation throughout the body.
In mild cases, cytokine release syndrome causes symptoms such as fever, headache, and nausea. In severe cases, cytokine release syndrome can lead to organ failure and death.
Treatment for cytokine release syndrome depends on the severity but might include immunosuppressive medications, oxygen support, blood transfusions, and medications for symptom management.