{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T02:42:16Z","timestamp":1788835336363,"version":"build-2803163510"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Pharm Health Care Sci"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Epcoritamab, a subcutaneous CD3\u00d7CD20 bispecific antibody, has demonstrated promising activity in relapsed or refractory diffuse large B\u2011cell lymphoma. Cytokine release syndrome (CRS) is a key adverse event associated with T\u2011cell\u2013engaging therapies; however, it typically occurs early after treatment initiation and is generally manageable with step\u2011up dosing and premedication. Evidence regarding the safety of delivering radiotherapy during late-phase epcoritamab therapy remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 58-year-old man with diffuse large B-cell lymphoma received epcoritamab. On cycle 8\u00a0day 8, local radiotherapy (40\u00a0Gy in 20 fractions) was initiated for a residual abdominal lymph node lesion. Approximately 12\u00a0h after the second radiotherapy fraction, he developed fever (38\u00a0\u00b0C) and fatigue without hypotension or hypoxia and without neutropenia, consistent with a CRS-compatible febrile episode (grade 1 by the American Society for Transplantation and Cellular Therapy criteria). Blood cultures were obtained and empiric cefepime with acetaminophen was initiated, resulting in transient defervescence; however, fever recurred approximately 12\u00a0h after the third radiotherapy fraction. Blood cultures, (1,3)-\u03b2-D-glucan, and galactomannan assays were negative. Given the reproducible temporal association with radiotherapy, a CRS-compatible event was considered, and tocilizumab (8\u00a0mg\/kg) was administered in line with standard CRS management guidance, with defervescence within 1\u00a0h. He remained afebrile thereafter and completed radiotherapy without recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CRS-compatible fever is uncommon after multiple cycles of epcoritamab. This case suggests a temporal association between radiotherapy and a CRS-compatible febrile episode during late-phase therapy and supports the possibility that radiotherapy acted as an inflammatory trigger. When radiotherapy is delivered during bispecific antibody therapy, fever should prompt concurrent evaluation for infection while keeping CRS in the differential diagnosis, and standard CRS management should be applied promptly when clinically indicated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40780-026-00568-0","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T08:37:40Z","timestamp":1774600660000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cytokine release syndrome-compatible fever after initiation of local radiotherapy during late-phase epcoritamab therapy in relapsed\/refractory diffuse large B-cell lymphoma: a case report"],"prefix":"10.1186","volume":"12","author":[{"given":"Naoaki","family":"Nishimura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajime","family":"Nakashima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuto","family":"Ogasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Yoshikuni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Kohno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Ogawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"issue":"7","key":"568_CR1","doi-asserted-by":"publisher","first-page":"1483","DOI":"10.3324\/haematol.2024.285343","volume":"110","author":"AG Minson","year":"2025","unstructured":"Minson AG, Dickinson MJ. New bispecific antibodies in diffuse large B-cell lymphoma. Haematologica. 2025;110(7):1483\u201399. https:\/\/doi.org\/10.3324\/haematol.2024.285343.","journal-title":"Haematologica"},{"key":"568_CR2","doi-asserted-by":"publisher","first-page":"2653","DOI":"10.1038\/s41375-024-02410-8","volume":"38","author":"C Thieblemont","year":"2024","unstructured":"Thieblemont C, Karimi YH, Ghesquieres H, Cheah CY, Clausen MR, Cunningham D, et al. Epcoritamab in relapsed\/refractory large B-cell lymphoma: 2-year follow-up from the pivotal EPCORE NHL-1 trial. Leukemia. 2024;38:2653\u201362. https:\/\/doi.org\/10.1038\/s41375-024-02410-8.","journal-title":"Leukemia"},{"key":"568_CR3","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1002\/cpt.3751","volume":"118","author":"C Jamois","year":"2025","unstructured":"Jamois C, Turner DC, Gibiansky L, Li F, Menuet J, Pereira LR, et al. 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J Clin Oncol. 2023;41:2238\u201347. https:\/\/doi.org\/10.1200\/JCO.22.01725.","journal-title":"J Clin Oncol"},{"key":"568_CR7","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1016\/S0140-6736(21)00889-8","volume":"398","author":"M Hutchings","year":"2021","unstructured":"Hutchings M, Mous R, Clausen MR, Johnson P, Linton KM, Chamuleau MED, et al. Dose escalation of subcutaneous epcoritamab in patients with relapsed or refractory B-cell non-Hodgkin lymphoma: an open-label, phase 1\/2 study. Lancet. 2021;398:1157\u201369. https:\/\/doi.org\/10.1016\/S0140-6736(21)00889-8.","journal-title":"Lancet"},{"key":"568_CR8","doi-asserted-by":"publisher","first-page":"1437","DOI":"10.1002\/cpt.3588","volume":"117","author":"T Li","year":"2025","unstructured":"Li T, Gibiansky L, Parikh A, Putnins M, Chiu CW, Sacchi M, et al. Optimal dosing regimen for epcoritamab, a subcutaneous bispecific antibody, in relapsed or refractory large B-cell lymphoma. 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