Headache and Fever

1. Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) represent a spectrum of inflammatory side effects associated with T-cell targeted therapies, such as CAR-T. 2. Patients with CAR-T related CRS and/or ICANS toxicities have favorable prognosis and are expected to recover without persistent side-effects if symptoms are recognized early and managed rapidly. These toxicities are relatively reversible and require prompt collaboration between the ED provider, oncologist, and other specialists. 3. The American Society for Blood and Marrow Transplantation (ASTCT) grading scale is commonly utilized to characterize the severity of CRS and ICANS with management recommendations based on severity grade. 4. IL-6 inhibitors such as tocilizumab do not cross the blood-brain barrier and should not be used for ICANS treatment unless there is concomitant CRS. 5. Consider early transfer for higher level of care, even if patient has a low CRS grade, if IL-6 inhibitors are not available for administration at your hospital.