Three days after infusion of tisagenlecleucel (anti-CD19 CAR-T cells), a 12-year-old with ALL develops fever 40 degrees C, hypotension requiring vasopressors, and hypoxia. Ferritin is markedly elevated. The most appropriate first-line drug is:
- A Tocilizumab ✓
- B Anakinra
- C High-dose methylprednisolone alone
- D Etanercept
Correct answer: A. Tocilizumab
Explanation
This is grade 3 to 4 cytokine release syndrome driven by massive IL-6 release from activated T cells and monocytes. Tocilizumab, an anti-IL-6 receptor antibody, is the established first-line agent and typically produces rapid defervescence and hemodynamic improvement. Corticosteroids are added if tocilizumab fails or neurotoxicity supervenes, but they are not first-line alone. Anakinra (IL-1 receptor antagonist) and etanercept (TNF blocker) are not standard for CAR-T CRS.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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