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Review article
Available online 15 September 2025
Cytokine release syndrome and hemophagocytic syndrome associated with immunotherapy: A narrative review
Síndrome de liberación de citocinas y síndrome hemofagocítico asociados a inmunoterapia: una revisión narrativa
Eric Mayor-Vázqueza,b,k, Elena Cuenca Fitoc,k,
, Pilar Marcos-Neirad,e,k, Cándido Díaz-Lagaresf,g,k, Carme Gomila-Sintesh,k, Noelia Albalái,k, Alejandra García-Rochef,g,k, Pedro Castroa,b,j,k
a Hospital Clínic Barcelona (HCB), Barcelona, Spain
b Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
c Complexo Hospitalario Universitario de Ourense (CHUO), Ourense, Spain
d Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
e Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
f Hospital Vall d’Hebron, Barcelona, Spain
g Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
h Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
i Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
j Institut d’investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
k Grupo de Trabajo en Hemostasia, Hematología y Oncología Crítica (GTHHOC), Sociedad Española de Medicina Intensiva y Unidades Coronarias (SEMICYUC), Spain
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Received 01 March 2025. Accepted 29 May 2025
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Table 2. HLH-2004 and HScore criteria for the diagnosis of sHLH.
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Table 3. Main infectious etiologies in the oncohematological population.
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Abstract

In recent years, there has been an increase in the number of patients affected by oncohematologic diseases in developed countries due to the improved survival rates and quality of life. This increase has generated a greater need for care in intensive care units (ICU), mainly due to complications related to immunosuppression, treatment toxicity or complications derived from cancer itself. Immunotherapy has transformed cancer treatment, but it can cause serious side effects such as cytokine release syndrome and hemophagocytic syndrome, which often require ICU admission. This review seeks to expand knowledge and management strategies for these complications in the ICU.

Keywords:
Oncology
Hematology
Immunotherapy
Cytokine release syndrome
Hemophagocytic syndrome
Hemophagocytic lymphohistiocytosis
Resumen

En los últimos años se ha producido un incremento de pacientes afectos por enfermedades oncohematológicas en los países desarrollados, secundario a la mejora en las tasas de supervivencia y la calidad de vida. Este aumento ha generado una mayor necesidad de asistencia de los mismos en los servicios de medicina intensiva (SMI), principalmente debido a complicaciones relacionadas con inmunosupresión, la toxicidad del tratamiento o complicaciones derivadas del propio cáncer. La inmunoterapia ha transformado el tratamiento del cáncer, pero puede causar efectos secundarios graves como el síndrome de liberación de citocinas y el síndrome hemofagocítico, los cuales a menudo requieren ingreso en los SMI. Esta revisión busca expandir el conocimiento y las estrategias de manejo de estas complicaciones en los SMI.

Palabras clave:
Oncología
Hematología
Inmunoterapia
Síndrome de liberación de citocinas
Síndrome hemofagocítico
Linfohistiocitosis hemofagocítica

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