Supportive care measures for patients with severe/refractory CRS or ICANS
| Neurology |
| • Identify patients at high risk of developing ICANS and engage neurology early113 |
| • Tailor duration of steroids in patients with severe ICANS to treat toxicity but limit adverse side effects |
| Immune/hematologic |
| • Limit the duration of high-dose steroids for the management of toxicity to diminish immune suppression |
| • Use cytokine-directed treatments, such as anakinra, as a steroid-sparing approach20,43,57 |
| • Optimize approaches to treat ongoing cytopenias |
| Infectious disease |
| • Use prophylactic antimicrobials, such as trimethoprim-sulfamethoxazole, for Pneumocystis jirovecii prophylaxis22 |
| • Use prophylactic antivirals, such as acyclovir or valacyclovir, for herpes virus prophylaxis before conditioning chemotherapy22 |
| • Practice antibiotic stewardship with broad-spectrum antibiotics and blood cultures for patients with neutropenic fever114,115 |
| • Assess for CMV, adeno- or other viremias in patients with persistent cytopenia after treatment |
| • Optimize antifungal prophylaxis in patients with prolonged immunosuppression due to CRS/ICANS management and cytopenias |
| Rehabilitation |
| • Involve inpatient rehabilitation services for patients, particularly those with lengthy hospital stays or those who received prolonged steroids, after they are clinically stable |
| • Encourage engagement of caregivers and social workers |
| Cognitive/psychosocial |
| • Consult psychiatry or psychiatric oncology to aid in the management of delirium, particularly in older or pediatric patients who develop ICANS |
| Neurology |
| • Identify patients at high risk of developing ICANS and engage neurology early113 |
| • Tailor duration of steroids in patients with severe ICANS to treat toxicity but limit adverse side effects |
| Immune/hematologic |
| • Limit the duration of high-dose steroids for the management of toxicity to diminish immune suppression |
| • Use cytokine-directed treatments, such as anakinra, as a steroid-sparing approach20,43,57 |
| • Optimize approaches to treat ongoing cytopenias |
| Infectious disease |
| • Use prophylactic antimicrobials, such as trimethoprim-sulfamethoxazole, for Pneumocystis jirovecii prophylaxis22 |
| • Use prophylactic antivirals, such as acyclovir or valacyclovir, for herpes virus prophylaxis before conditioning chemotherapy22 |
| • Practice antibiotic stewardship with broad-spectrum antibiotics and blood cultures for patients with neutropenic fever114,115 |
| • Assess for CMV, adeno- or other viremias in patients with persistent cytopenia after treatment |
| • Optimize antifungal prophylaxis in patients with prolonged immunosuppression due to CRS/ICANS management and cytopenias |
| Rehabilitation |
| • Involve inpatient rehabilitation services for patients, particularly those with lengthy hospital stays or those who received prolonged steroids, after they are clinically stable |
| • Encourage engagement of caregivers and social workers |
| Cognitive/psychosocial |
| • Consult psychiatry or psychiatric oncology to aid in the management of delirium, particularly in older or pediatric patients who develop ICANS |