Five days after infusion of axi-cel (a CD19-directed CAR-T product) for diffuse large B-cell lymphoma, a patient develops fever of 39.5 degrees Celsius, hypotension requiring vasopressors, and hypoxia needing supplemental oxygen. Serum ferritin and CRP are markedly elevated. The most appropriate first-line drug is:
- A Rituximab, to deplete the activated B-cell population
- B Nivolumab, to reinvigorate antitumour T cells
- C Tocilizumab, an anti-IL-6 receptor antibody ✓
- D Imatinib, to suppress off-target kinase activation
Correct answer: C. Tocilizumab, an anti-IL-6 receptor antibody
Explanation
This is grade 3 to 4 cytokine release syndrome following CAR-T cell infusion, driven largely by IL-6 released from activated macrophages and T cells. Tocilizumab, an anti-IL-6 receptor antibody, is the standard first-line agent, with corticosteroids added if response is inadequate. Checkpoint inhibitors, rituximab and TKIs have no role in managing CRS.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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