CRS Grading (ASTCT 2019)

ASTCT Consensus Grading: Standardized criteria for Cytokine Release Syndrome. Grade is dictated by the highest severity level reached in any category (Fever, Hypotension, Hypoxia).

1. Temperature

2. Hypotension

3. Hypoxia

ASTCT 2019 CRS Grade

-

Patient does not meet the ASTCT 2019 criteria for CRS (Fever is mandatory).

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

Grading the severity of Cytokine Release Syndrome (CRS) following immune effector cell (IEC) therapy (e.g., CAR-T).

To guide clinical management, including the initiation of tocilizumab and corticosteroids.

Standardizing toxicity reporting across clinical trials and institutional protocols.

Patient Population

Adult and pediatric patients receiving CAR-T cells, bispecific antibodies (BiTEs), or other immune effector cell therapies.

When Not to Rely on This Score Alone

Sepsis or septic shock — must exclude infection as the primary cause of fever and hypotension.

Tumor Lysis Syndrome (TLS) — although frequently co-occurring, TLS has separate management and grading.

Neurotoxicity (ICANS) — requires separate assessment using the ICE score and ASTCT ICANS grading.

How it Works

Grading Logic

CRS grade is determined by the most severe symptom among fever, hypotension, and hypoxia. A fever (≥ 38.0°C) is required for the diagnosis of CRS.

ASTCT 2019 Grading Schema

Grade	Fever	Hypotension	Hypoxia
1	≥ 38°C	None	None
2	≥ 38°C	Not requiring vasopressors	Low-flow O2 (< 6 L/min)
3	≥ 38°C	One vasopressor (± vasopressin)	High-flow O2 (≥ 6 L/min)
4	≥ 38°C	Multiple vasopressors	Positive pressure (CPAP, BiPAP, Intubation)

Last Comprehensive Review: 2026-07-17

In Recent Clinical News

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CRS Grading (ASTCT 2019)

1. Temperature

2. Hypotension

3. Hypoxia

-

When to Use

When to Use

Patient Population

When Not to Rely on This Score Alone

How it Works

Grading Logic

ASTCT 2019 Grading Schema

Clinical Pearls

The Fever Requirement

Management Triggers

The Evidence

Primary Scale

ASTCT Consensus Grading for Cytokine Release Syndrome and Immune Effector Cell-Associated Neurotoxicity Syndrome in Adult and Pediatric Patients.

Origins & History

Historical Context

In Recent Clinical News

CRS Grading (ASTCT 2019)

1. Temperature

2. Hypotension

3. Hypoxia

-

When to Use

When to Use

Patient Population

When Not to Rely on This Score Alone

How it Works

Grading Logic

ASTCT 2019 Grading Schema

Clinical Pearls

The Fever Requirement

Management Triggers

The Evidence

Primary Scale

ASTCT Consensus Grading for Cytokine Release Syndrome and Immune Effector Cell-Associated Neurotoxicity Syndrome in Adult and Pediatric Patients.

Origins & History

Historical Context

In Recent Clinical News