‘Key Signs’ of Cytokine Release Syndrome to Know


For patients with lymphoma or multiple myeloma, speaking up about symptoms of cytokine release syndrome can be lifesaving.

It’s important for patients receiving bispecific antibodies for lymphoma or multiple myeloma to recognize “key signs” of cytokine release syndrome (CRS), said Andrea Wagner.

This side effect, if identified early, can be mitigated after receiving the immunosuppressive drug, Actemra (tocilizumab). However, knowing the symptoms and actively communicating with providers is essential for patients, Wagner noted.

Wagner is a clinical oncology nurse specialist at Hackensack University Medical Center in New Jersey.

CRS is a condition that may occur after treatment with certain monoclonal antibodies and CAR-T cell therapies. This happens when the body rapidly releases cytokines in the blood from immune cells after receiving immunotherapy, as the National Cancer Institute defines.

READ MORE: Nurse Suggests Questions to Ask Before Carvykti Treatment for Myeloma

“We really want to make sure that we're identifying cytokine release syndrome as soon as possible,” she explained, notably because it can be “deadly if left untreated.”

So, Wagner emphasized the importance for patients to voice their symptoms and side effects when they experience them.

“We do try to give heavy patient education when they sign the consent for the drug, these bispecifics for multiple myeloma and lymphoma come with an inpatient admission,” she said. “So whether we’re giving you the first full dose, we will make sure to educate [patients] in terms of what they’re looking for.

“But it’s so important to speak up with anything that you may feel,” Wagner added. “It is scary because it is different and it can be severe. But if caught early, we can treat it and stop it from getting to that point.”


So when we talk about cytokine release syndrome, I really relate it [to the way] it mimics sepsis. And basically, I say it's like your vital signs. So if you feel any heart palpitations, which could be a sign of increased heart rate, it's important to let your provider know.

If you have a fever, which is the number one sign of CRS, [it’s] important to report it to your provider. Blood pressure plays a role in this. So if you feel dizzy [or] lightheaded, again, letting your provider know, and headaches as well. So those are all your key signs, as well as trouble breathing, that you should be reporting to your physician.

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