Bispecific T-cell engagers cause cytokine release syndrome most often after the first doses. It typically presents with fever, then may progress to hypotension and hypoxia. Grading uses the ASTCT consensus criteria, and treatment escalates with grade, including tocilizumab and corticosteroids for more severe reactions.
Patients may present to emergency departments or general wards, where the link with recent cancer treatment can be missed. Infection must still be excluded in parallel, especially in neutropenic patients.
- Ask about bispecific antibody treatment in any patient with cancer presenting with fever.
- Check blood pressure and oxygen saturation; hypotension or hypoxia indicates higher-grade reactions.
- Contact the treating oncology team early; protocols guide tocilizumab and steroid use.
- Look for confusion or speech change, which may signal neurotoxicity.
Why it matters
As T-cell engagers spread beyond haematology, more first presentations will reach non-specialists.
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