A child with relapsed B-cell acute lymphoblastic leukaemia receives blinatumomab and develops fever, hypotension, hypoxia and confusion within hours of the first infusion. The immediate management step is:

• A Stop the infusion and give dexamethasone with supportive care ✓
• B Administer tocilizumab
• C Give broad-spectrum antibiotics and continue the infusion
• D Exchange transfusion

Explanation

Blinatumomab is a bispecific T-cell engager linking CD19 on blasts to CD3 on T cells, forcing polyclonal T-cell activation with massive IFN-gamma, TNF and IL-2 release. Cytokine release syndrome here is treated by interrupting the infusion, giving corticosteroids and supportive care; tocilizumab is the standard rescue for CRS caused by CAR-T cells, though it may be used if steroids fail. Antibiotics alone do not address the mechanism.

Reference: Nelson Textbook of Pediatrics, 22nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.