Table 3

CRS grading systems

InstitutionGrade 1Grade 2Grade 3Grade 4
NCI Mild reaction; infusion interruption not indicated; intervention not indicated Therapy or infusion interruption indicated but responds promptly to symptomatic treatment; prophylactic medications indicated for ≤24 h Severe symptoms including any 1 or more of the following: a drop in blood pressure ≥20% from baseline, not responsive to fluid within 24 h; grade 3 respiratory dysfunction; grade 3 creatinine indicative of renal dysfunction; grade 3 neurological dysfunction Life-threatening consequences; vasopressor or ventilator support indicated 
UPenn13  Mild reaction; treated with supportive care Moderate: requiring IV therapies; some signs of organ dysfunction related to CRS; hospitalization for management of CRS-related symptoms including fevers with associated neutropenia More severe reaction: hospitalization required for management of symptoms related to organ dysfunction including grade 4 liver function test or grade 3 creatinine elevation related to CRS; includes hypotension treated with IV fluids or low-dose pressors Life-threatening complications such as hypotension requiring high-dose pressors, hypoxia requiring mechanical ventilation 
InstitutionGrade 1Grade 2Grade 3Grade 4
NCI Mild reaction; infusion interruption not indicated; intervention not indicated Therapy or infusion interruption indicated but responds promptly to symptomatic treatment; prophylactic medications indicated for ≤24 h Severe symptoms including any 1 or more of the following: a drop in blood pressure ≥20% from baseline, not responsive to fluid within 24 h; grade 3 respiratory dysfunction; grade 3 creatinine indicative of renal dysfunction; grade 3 neurological dysfunction Life-threatening consequences; vasopressor or ventilator support indicated 
UPenn13  Mild reaction; treated with supportive care Moderate: requiring IV therapies; some signs of organ dysfunction related to CRS; hospitalization for management of CRS-related symptoms including fevers with associated neutropenia More severe reaction: hospitalization required for management of symptoms related to organ dysfunction including grade 4 liver function test or grade 3 creatinine elevation related to CRS; includes hypotension treated with IV fluids or low-dose pressors Life-threatening complications such as hypotension requiring high-dose pressors, hypoxia requiring mechanical ventilation 
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