ASTCT CONSENSUSCAR-T Toxicity Grading (CRS & ICANS)

Toxicity Severity

CRS Grade (Cytokine Release)

ICANS Grade (Neurotoxicity)

CRS Key Factors

Fever, Hypotension (BP), and Hypoxia (O2 Saturation).

ICANS Key Factors

ICE Score (orientation/writing), Level of consciousness, and Seizures.

Management Priority

STABLE MONITORING

Clinical Framing

Standard monitoring per institutional CAR-T protocol.

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

Monitoring patients after infusion of CAR-T cells or bispecific T-cell engagers (BiTEs).

Used to determine the timing and dosage of Tocilizumab (IL-6 inhibitor) and corticosteroids.

Requires vital signs (BP, O2 sats) and the ICE (Immune Effector Cell-Associated Encephalopathy) score.

How it Works

CRS Grading (Fever-Driven)

Grade	Hypotension	Hypoxia
Grade 1	None	None
Grade 2	Responding to fluids	Low-flow nasal cannula
Grade 3	Requiring 1 vasopressor	High-flow nasal cannula / Face mask
Grade 4	Requiring multiple vasopressors	Positive pressure (CPAP/BiPAP/Vent)

ICANS Grading (ICE-Driven)

Grade	ICE Score	Other Features
Grade 1	7 - 9	None
Grade 2	3 - 6	None
Grade 3	0 - 2	Any seizure (resolved) or focal edema
Grade 4	0 (Comatose)	Life-threatening seizure or diffuse edema

Last Comprehensive Review: 2026

ASTCT CONSENSUSCAR-T Toxicity Grading (CRS & ICANS)

Toxicity Severity

CRS Grade (Cytokine Release)

ICANS Grade (Neurotoxicity)

CRS Key Factors

Fever, Hypotension (BP), and Hypoxia (O2 Saturation).

ICANS Key Factors

ICE Score (orientation/writing), Level of consciousness, and Seizures.

Management Priority

STABLE MONITORING

Clinical Framing

Standard monitoring per institutional CAR-T protocol.

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

Monitoring patients after infusion of CAR-T cells or bispecific T-cell engagers (BiTEs).

Used to determine the timing and dosage of Tocilizumab (IL-6 inhibitor) and corticosteroids.

Requires vital signs (BP, O2 sats) and the ICE (Immune Effector Cell-Associated Encephalopathy) score.

How it Works

CRS Grading (Fever-Driven)

Grade	Hypotension	Hypoxia
Grade 1	None	None
Grade 2	Responding to fluids	Low-flow nasal cannula
Grade 3	Requiring 1 vasopressor	High-flow nasal cannula / Face mask
Grade 4	Requiring multiple vasopressors	Positive pressure (CPAP/BiPAP/Vent)

ICANS Grading (ICE-Driven)

Grade	ICE Score	Other Features
Grade 1	7 - 9	None
Grade 2	3 - 6	None
Grade 3	0 - 2	Any seizure (resolved) or focal edema
Grade 4	0 (Comatose)	Life-threatening seizure or diffuse edema

Last Comprehensive Review: 2026

ASTCT Grading

Toxicity Severity

STABLE MONITORING

When to Use

When to Use

How it Works

CRS Grading (Fever-Driven)

ICANS Grading (ICE-Driven)

Clinical Pearls

The Fever Requirement

Management Trigger

The Evidence

Key Reference

ASTCT Consensus Grading for Cytokine Release Syndrome and Immune Effector Cell-Associated Neurotoxicity Syndrome

Related Tools

Recent Journal Updates

ASTCT Grading

Toxicity Severity

STABLE MONITORING

When to Use

When to Use

How it Works

CRS Grading (Fever-Driven)

ICANS Grading (ICE-Driven)

Clinical Pearls

The Fever Requirement

Management Trigger

The Evidence

Key Reference

ASTCT Consensus Grading for Cytokine Release Syndrome and Immune Effector Cell-Associated Neurotoxicity Syndrome

Related Tools

Recent Journal Updates