OBJECTIVES: To describe a pediatric case of cytokine release syndrome secondary 
to chimeric antigen receptor-modified T cells associated with acute respiratory 
distress syndrome.
DESIGN: Case report.
SETTING: PICU.
PATIENTS: A 14-year-old boy with refractory B cell precursor acute lymphoblastic 
leukemia given chimeric antigen receptor cells developed severe cytokine release 
syndrome 7 days after the drug product infusion with progressive respiratory 
failure. He was admitted to PICU with a clinical picture of acute respiratory 
distress syndrome, requiring mechanical ventilation, and secondary 
hemophagocytic lymphohistiocytosis.
INTERVENTIONS: Hemoadsorption with cartridge column (Cytosorb) in combination 
with continuous renal replacement therapy was associated to the anti-cytokine 
therapy (tocilizumab, a monoclonal antibody targeting interleukin-6 receptor).
MEASUREMENTS AND MAIN RESULTS: Decrease of the inflammatory biomarkers 
(ferritin, interleukin-6, interleukin-10) in the first 96 hours associated with 
a progressive improvement of acute respiratory distress syndrome (Pao2/Fio2 
ratio) 7 day after the start of the multimodal treatment.
CONCLUSIONS: This case suggests that hemoadsorption with cartridge column in 
combination with continuous renal replacement therapy and tocilizumab is safe 
and potentially effective in pediatric patients with severe cytokine release 
syndrome.