Cytokine Release Syndrome (CRS) prevention and management

Tocilizumab (toci) is an anti-IL-6 antibody designed to interrupt the inflammatory process that causes cytokine release syndrome. 

At present, toci is typically used in patients who have already developed CRS after starting on a bispecific antibody, however, research efforts have further expanded on evaluating the prophylactic role of toci in CRS occurrence. 

After testing what effect preventative toci could have against CRS, Ellen Marin, PA-C, and her research team at Winship Cancer Institute at Emory University Hospital reported on their findings at the American Society of Hematology (ASH) 2023. Teclistamab was the bispecific antibody used in this study.  

• CRS occurred in 10 of the 33 patients (30.3%) who received prophylactic tocilizumab compared to 11 of 15 (73.3%) of patients who did not. 
• In terms of patient complications during the trial, the majority of CRS events with prophylactic tocilizumab were grade 1. There was one patient that had grade 2 CRS and another had grade 3. 
• These results are lower in absolute incidence and severity when compared to the original FDA-approving MajesTEC-1 clinical trial, where CRS with teclistamab was seen in 72% of patients.

Current investigations are focused on identifying earlier which patients are at a higher risk of experiencing CRS so it can be prevented. Gathering real-world data is important for figuring out the best strategies to prevent CRS.

There is also emerging information about wearable technology devices that can detect CRS early within patients. While expensive, these could be a potential option in preventing serious complications when myeloma patients receive their bispecific antibody therapy at home. However, these are currently not used in routine clinical practice.