{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T06:24:21Z","timestamp":1792218261124,"version":"4.4.0"},"reference-count":20,"publisher":"American Society of Hematology","issue":"4","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,2,25]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Various grading systems are currently used for chimeric antigen receptor (CAR) T-cell\u2013related toxicity, cytokine release syndrome (CRS), and immune effector cell\u2013associated neurotoxicity syndrome (ICANS). We compared the recently proposed American Society for Transplantation and Cellular Therapy (ASTCT) grading system to other grading scores in 2 populations of adults: patients (n = 53) with B-cell acute lymphoblastic leukemia (B-ALL) treated with 1928z CAR T-cells (clinicaltrials.gov #NCT01044069), and patients (n = 49) with diffuse large B-cell lymphoma (DLBCL) treated with axicabtagene-ciloleucel (axi-cel) or tisagenlecleucel after US Food and Drug Administration approval. According to ASTCT grading, 82% of patients had CRS, 87% in the B-ALL and 77% in the DLBCL groups (axi-cel: 86%, tisagenlecleucel: 54%), whereas 50% of patients experienced ICANS, 55% in the B-ALL and 45% in the DLBCL groups (axi-cel: 55%, tisagenlecleucel: 15%). All grading systems agreed on CRS and ICANS diagnosis in 99% and 91% of cases, respectively. However, when analyzed grade by grade, only 25% and 54% of patients had the same grade in each system for CRS and ICANS, respectively, as different systems score symptoms differently (upgrading or downgrading their severity), leading to inconsistent final grades. Investigation of possible management implications in DLBCL patients showed that different recommendations on tocilizumab and steroids across current guidelines potentially result in either overtreating or delaying treatment. Moreover, because these guidelines are based on single products and different grading systems, they cannot be universally applied. To avoid discrepancies in assessing and managing toxicities of different products, we propose that unified grading be used across clinical trials and in practice and that paired management guidelines with product-specific indications be developed.<\/jats:p>","DOI":"10.1182\/bloodadvances.2019000952","type":"journal-article","created":{"date-parts":[[2020,2,21]],"date-time":"2020-02-21T16:39:39Z","timestamp":1582303179000},"page":"676-686","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":155,"title":["Comparing CAR T-cell toxicity grading systems: application of the ASTCT grading system and implications for management"],"prefix":"10.1182","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1077-5937","authenticated-orcid":false,"given":"Martina","family":"Pennisi","sequence":"first","affiliation":[{"name":"Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;"},{"name":"Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy;"},{"name":"Division of Hematology, Department of Oncology and Hemato-oncology, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"Jain","sequence":"first","affiliation":[{"name":"Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca D.","family":"Santomasso","sequence":"first","affiliation":[{"name":"Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY;"},{"name":"Department of Medicine, Weill Cornell Medical College, New York, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Mead","sequence":"first","affiliation":[{"name":"Department of Medicine, Weill Cornell Medical College, New York, NY;"},{"name":"Department of Anesthesiology and Critical Care Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kitsada","family":"Wudhikarn","sequence":"first","affiliation":[{"name":"Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY;"},{"name":"Unit of Translational Hematology, Division of Hematology and Research, Department of Medicine, Chulalongkorn University, Bangkok, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari Lynne","family":"Silverberg","sequence":"first","affiliation":[{"name":"Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yakup","family":"Batlevi","sequence":"first","affiliation":[{"name":"Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roni","family":"Shouval","sequence":"first","affiliation":[{"name":"Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean M.","family":"Devlin","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9036-9463","authenticated-orcid":false,"given":"Connie","family":"Batlevi","sequence":"first","affiliation":[{"name":"Department of Medicine, Weill Cornell Medical College, New York, NY;"},{"name":"Lymphoma Service, Department of Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renier J.","family":"Brentjens","sequence":"first","affiliation":[{"name":"Department of Medicine, Weill Cornell Medical College, New York, NY;"},{"name":"Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; 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and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly","family":"Maloy","sequence":"first","affiliation":[{"name":"Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Lia","family":"Palomba","sequence":"first","affiliation":[{"name":"Department of Medicine, Weill Cornell Medical College, New York, NY;"},{"name":"Lymphoma Service, Department of Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Sanchez-Escamilla","sequence":"first","affiliation":[{"name":"Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;"},{"name":"Department of Hematological Malignancies and Stem Cell Transplantation, Research Institute of Marques de Valdecilla, Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig S.","family":"Sauter","sequence":"first","affiliation":[{"name":"Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;"},{"name":"Department of Medicine, Weill Cornell Medical College, New York, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Scordo","sequence":"first","affiliation":[{"name":"Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;"},{"name":"Department of Medicine, Weill Cornell Medical College, New York, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunjan","family":"Shah","sequence":"first","affiliation":[{"name":"Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;"},{"name":"Department of Medicine, Weill Cornell Medical College, New York, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae H.","family":"Park","sequence":"first","affiliation":[{"name":"Department of Medicine, Weill Cornell Medical College, New York, NY;"},{"name":"Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; 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