Clinical characteristics, treatment and prognosis of nivolumab induced cytokine release syndrome.
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BACKGROUND: To explore the clinical patterns of nivolumab-induced cytokine release syndrome (CRS), and to provide a basis for diagnosis, treatment and prognosis. METHODS: Clinical reports of nivolumab-induced CRS before March 31, 2026 were collected, and clinical data were extracted for retrospective analysis. RESULTS: Thirty-five patients were included, with a median age of 55 years (range 3, 86). The median time for the appearance of CRS was 54.5 days (range 0.2, 391) and the median number of cycles was 3 (range 1, 17). Fever (85.7%), hypotension (57.1%), tachycardia (42.9%), fatigue (25.7%), rash (25.7%) and impaired consciousness (25.7%) were the main symptoms of patients. Laboratory tests may reveal liver injury, renal injury, elevated C-reactive protein, elevated ferritin, and elevated interleukin-6. After discontinuing nivolumab and receiving treatment with glucocorticoids and tocilizumab, 71.4% of the patients showed improvement in symptoms and clinical markers, while 28.6% of the patients died. CONCLUSION: Nivolumab-induced CRS can lead to multi-organ functional impairment and even be fatal. During the administration of nivolumab, the possibility of CRS should be taken into consideration. Glucocorticoids and tocilizumab are widely utilized as primary therapeutic approaches for the management of CRS in clinical practice. However, given the limited available evidence and inherent clinical confounders, the standardized and optimal treatment strategy for nivolumab-induced CRS remains undefined and requires further exploration.