Restrictions

CAR T-cell therapy associated CRS or ICANS 

• inpatient, infusion center
• restricted to oncology services

Patients with SARS-CoV 2 (COVID-19) with the following criteria of use: 

Inclusion:

• Confirmed SARS-CoV-2 AND
• Requiring >6L of O2 for > 24 hours AND
• Receiving dexamethasone for > 24 hours AND
• Does not respond to standard of care OR
• Decompensates within 7 days of hospitalization (requiring > 6L of O2)

Exclusions:

• Active systemic bacterial or fungal co-infection 
• ALT or AST > 10x ULN
• Known hypersensitivity to tocilizumab 
• More than 7 days have elapsed since admitted to hospital with symptoms of an acute illness due to SARS-CoV-2
• Enrolment in a study that excludes the use of tocilizumab (e.g ACTIV-1 trial)

Baseline Screening:

• CBC
• *TB test – IGRA
• *HepB test 

* The therapy plans require these tests at baseline. But we cannot reasonably wait for the results prior to administering the medication. The intent is to still order the test, but to administer the drug without waiting for the results.

*Currently being built in therapy plan that includes diagnostic labs/tests. Question about data showing benefit as prior data may not have shown benefit due to patient population in study however new data does show benefit. These criteria do NOT require the patient to be on a ventilator or to be in the ICU

• UpToDate
• Lexicomp
• DailyMed Package Inserts
• Johns Hopkins Guides