Immunology: cytokine release syndrome: practice question

A Microbiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Microbiology · Immunology: cytokine release syndrome

Sample item

Three days after infusion of anti-CD19 CAR T cells for refractory lymphoma, a 52-year-old man develops fever of 39.5 degrees C and hypotension. Ferritin and C-reactive protein are markedly raised and there is no evidence of sepsis. Which targeted drug is most appropriate for severe cytokine release syndrome?

AEtanercept, a soluble TNF receptor fusion proteinBRituximab, an anti-CD20 antibodyCBasiliximab, an anti-CD25 antibodyDTocilizumab, an anti-IL-6 receptor antibody

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Tocilizumab, an anti-IL-6 receptor antibody

Activated CAR T cells and bystander macrophages release large amounts of IL-6, interferon-gamma and other cytokines, causing fever, hypotension and capillary leak. Blocking the IL-6 receptor with tocilizumab reverses most of the syndrome without destroying the CAR T cells. Corticosteroids are added if severe or refractory.

Option by option

A. Etanercept, a soluble TNF receptor fusion protein
Etanercept blocks TNF in rheumatoid disease and is not the established treatment for this syndrome.
B. Rituximab, an anti-CD20 antibody
Rituximab depletes B cells and would not interrupt the cytokine cascade.
C. Basiliximab, an anti-CD25 antibody
Basiliximab blocks IL-2 receptor to prevent transplant rejection and is not used here.
D. Tocilizumab, an anti-IL-6 receptor antibody (correct)
IL-6 receptor blockade is the standard targeted therapy for moderate to severe cytokine release syndrome.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Microbiology question

What is the answer to this Microbiology question?

The best answer is D, Tocilizumab, an anti-IL-6 receptor antibody. Activated CAR T cells and bystander macrophages release large amounts of IL-6, interferon-gamma and other cytokines, causing fever, hypotension and capillary leak.

Why is "Etanercept, a soluble TNF receptor fusion protein" not the answer?

Etanercept blocks TNF in rheumatoid disease and is not the established treatment for this syndrome.

Why is "Rituximab, an anti-CD20 antibody" not the answer?

Rituximab depletes B cells and would not interrupt the cytokine cascade.

Why is "Basiliximab, an anti-CD25 antibody" not the answer?

Basiliximab blocks IL-2 receptor to prevent transplant rejection and is not used here.

What concept does this question test?

It tests Immunology: cytokine release syndrome in Microbiology. Blocking the IL-6 receptor with tocilizumab reverses most of the syndrome without destroying the CAR T cells. Corticosteroids are added if severe or refractory.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Immunology: cytokine release syndrome?

Make a one-line identity card for each organism: shape and stain, defining test, toxin, disease and drug. Then use the flashcards and the other Microbiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.