# ASTCT consensus CRS grading

ASTCT CRS

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/astct_crs`
HTML: https://magentlab.com/docs/astct-crs
Markdown: https://magentlab.com/docs/astct-crs.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Apply Lee 2019 ASTCT Table 1 cytokine release syndrome grading and return grade 0–4 from caller-assigned fever, fever waiver, hypotension, and hypoxia. Grade is the more severe of hypotension versus hypoxia. Organ toxicities do not influence grade. Not ICANS.

## When to use

When an agent already has caller-assigned ASTCT CRS fever, hypotension, and hypoxia tokens and needs the published Table 1 grade. magent does not measure temperature, start vasopressors, or grade ICANS.

## When not to use

- Not a medical device and not a CRS diagnosis or a treatment, vasopressor, oxygen, or intubation order.
- magent does not measure temperature or start vasopressors. fever, fever_waived, hypotension, and hypoxia are caller-assigned Lee 2019 Table 1 tokens.
- Organ toxicities associated with CRS may be graded separately (for example CTCAE) but they do not influence ASTCT CRS grade.
- Not ICANS. This tool does not grade neurologic toxicity associated with immune effector cells.
- Grade 5 (death) is not returned. Both hypotension and hypoxia none without fever and without fever_waived is grade 0 (crs false), which is not a Table 1 row. Not Lee 2014.

## Formula

```
Lee 2019 ASTCT CRS Table 1. fever is temperature ≥38°C not attributable to another cause. fever_waived true if CRS already treated with antipyretic/tocilizumab/steroids so fever is no longer required. hypotension none | no_vasopressors | one_vasopressor (with or without vasopressin) | multiple_vasopressors (excluding vasopressin). hypoxia none | low_flow (≤6 L/min nasal cannula or blow-by) | high_flow (>6 L/min, facemask, NRB, or Venturi) | positive_pressure (CPAP/BiPAP/intubation). Grade is the more severe of hypotension vs hypoxia: both none → 1 if fever or fever_waived else 0 (crs false); no_vasopressors or low_flow → 2; one_vasopressor or high_flow → 3; multiple_vasopressors or positive_pressure → 4. Organ toxicities do not influence grade. Not ICANS
```

## Citation

[ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells](https://doi.org/10.1016/j.bbmt.2018.12.758)
Lee DW, Santomasso BD, Locke FL, Ghobadi A, Turtle CJ, Brudno JN, Maus MV, Park JH, Mead E, Pavletic S, Go WY, Eldjerou L, Gardner RA, Frey N, Curran KJ, Peggs K, Pasquini M, DiPersio JF, van den Brink MRM, Komanduri KV, Grupp SA, Neelapu SS
Biol Blood Marrow Transplant. 2019;25(4):625-638
DOI: [10.1016/j.bbmt.2018.12.758](https://doi.org/10.1016/j.bbmt.2018.12.758)

## Worked example

### Fever only, grade 1

Given: `fever=true, fever_waived=false, hypotension=none, hypoxia=none`

1. fever true; fever_waived false; hypotension none; hypoxia none
2. hypotension_grade 0 and hypoxia_grade 0; fever is present → grade 1
3. crs true


### Low-flow hypoxia, grade 2

Given: `fever=true, fever_waived=false, hypotension=none, hypoxia=low_flow`

1. fever true; hypotension none; hypoxia low_flow (≤6 L/min nasal cannula or blow-by)
2. More severe of 0 vs 2 → grade 2; crs true


### One vasopressor, grade 3

Given: `fever=true, fever_waived=false, hypotension=one_vasopressor, hypoxia=none`

1. fever true; hypotension one_vasopressor (with or without vasopressin); hypoxia none
2. More severe of 3 vs 0 → grade 3; crs true


### Positive-pressure hypoxia, grade 4

Given: `fever=true, fever_waived=false, hypotension=none, hypoxia=positive_pressure`

1. fever true; hypotension none; hypoxia positive_pressure (CPAP, BiPAP, or intubation)
2. More severe of 0 vs 4 → grade 4; crs true


### No fever and both axes none, grade 0

Given: `fever=false, fever_waived=false, hypotension=none, hypoxia=none`

1. fever false; fever_waived false; hypotension none; hypoxia none
2. No fever and no waiver → grade 0; crs false


## Also searched as

- ASTCT CRS grading
- cytokine release syndrome
- Lee 2019 CRS
- CAR T CRS grade
- ASTCT consensus grading
- immune effector cell CRS
- fever hypotension hypoxia CRS
- not ICANS

## Parameters

- `fever` (boolean, required): Fever as assigned by the caller (Lee 2019 ASTCT CRS Table 1): temperature ≥38°C not attributable to another cause. true or false. Required unless fever_waived is true when hypotension or hypoxia is not none. magent does not measure temperature.
- `fever_waived` (boolean, required): true if CRS was already treated with antipyretic, tocilizumab, or steroids so fever is no longer required to grade subsequent CRS (Lee 2019). false otherwise. magent does not start those therapies.
- `hypotension` (string, required): Lee 2019 Table 1 hypotension as assigned by the caller: none; no_vasopressors (hypotension not requiring vasopressors, grade 2); one_vasopressor (one vasopressor with or without vasopressin, grade 3); multiple_vasopressors (multiple vasopressors excluding vasopressin, grade 4). magent does not start vasopressors.
- `hypoxia` (string, required): Lee 2019 Table 1 hypoxia as assigned by the caller: none; low_flow (≤6 L/min nasal cannula or blow-by, grade 2); high_flow (>6 L/min nasal cannula, facemask, nonrebreather, or Venturi, grade 3); positive_pressure (CPAP, BiPAP, or intubation and mechanical ventilation, grade 4). magent does not set oxygen or ventilator mode.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/astct_crs`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "fever": "true",
      "fever_waived": "false",
      "hypotension": "none",
      "hypoxia": "none"
    },
    {
      "fever": "true",
      "fever_waived": "false",
      "hypotension": "none",
      "hypoxia": "none"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/astct-crs

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/astct_crs",
  "items": [
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Lee DW, Santomasso BD, Locke FL, Ghobadi A, Turtle CJ, Brudno JN, Maus MV, Park JH, Mead E, Pavletic S, Go WY, Eldjerou L, Gardner RA, Frey N, Curran KJ, Peggs K, Pasquini M, DiPersio JF, van den Brink MRM, Komanduri KV, Grupp SA, Neelapu SS",
        "doi": "10.1016/j.bbmt.2018.12.758",
        "id": "lee-2019",
        "pmid": "30592986",
        "source": "Biol Blood Marrow Transplant. 2019;25(4):625-638",
        "title": "ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells"
      },
      "formula": "astct_crs",
      "formula_expression": "Lee 2019 ASTCT CRS Table 1. fever is temperature ≥38°C not attributable to another cause. fever_waived true if CRS already treated with antipyretic/tocilizumab/steroids so fever is no longer required. hypotension none | no_vasopressors | one_vasopressor (with or without vasopressin) | multiple_vasopressors (excluding vasopressin). hypoxia none | low_flow (≤6 L/min nasal cannula or blow-by) | high_flow (>6 L/min, facemask, NRB, or Venturi) | positive_pressure (CPAP/BiPAP/intubation). Grade is the more severe of hypotension vs hypoxia: both none → 1 if fever or fever_waived else 0 (crs false); no_vasopressors or low_flow → 2; one_vasopressor or high_flow → 3; multiple_vasopressors or positive_pressure → 4. Organ toxicities do not influence grade. Not ICANS",
      "criteria": [
        {
          "factor": "fever_or_waived",
          "met": true
        },
        {
          "value": "none",
          "factor": "hypotension_none",
          "met": true
        },
        {
          "factor": "hypotension_no_vasopressors",
          "met": false
        },
        {
          "factor": "hypotension_one_vasopressor",
          "met": false
        },
        {
          "factor": "hypotension_multiple_vasopressors",
          "met": false
        },
        {
          "value": "none",
          "factor": "hypoxia_none",
          "met": true
        },
        {
          "factor": "hypoxia_low_flow",
          "met": false
        },
        {
          "factor": "hypoxia_high_flow",
          "met": false
        },
        {
          "factor": "hypoxia_positive_pressure",
          "met": false
        }
      ],
      "grade": 1,
      "crs": true,
      "fever": true,
      "fever_waived": false,
      "hypotension": "none",
      "hypotension_grade": 0,
      "hypoxia": "none",
      "hypoxia_grade": 0
    },
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Lee DW, Santomasso BD, Locke FL, Ghobadi A, Turtle CJ, Brudno JN, Maus MV, Park JH, Mead E, Pavletic S, Go WY, Eldjerou L, Gardner RA, Frey N, Curran KJ, Peggs K, Pasquini M, DiPersio JF, van den Brink MRM, Komanduri KV, Grupp SA, Neelapu SS",
        "doi": "10.1016/j.bbmt.2018.12.758",
        "id": "lee-2019",
        "pmid": "30592986",
        "source": "Biol Blood Marrow Transplant. 2019;25(4):625-638",
        "title": "ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells"
      },
      "formula": "astct_crs",
      "formula_expression": "Lee 2019 ASTCT CRS Table 1. fever is temperature ≥38°C not attributable to another cause. fever_waived true if CRS already treated with antipyretic/tocilizumab/steroids so fever is no longer required. hypotension none | no_vasopressors | one_vasopressor (with or without vasopressin) | multiple_vasopressors (excluding vasopressin). hypoxia none | low_flow (≤6 L/min nasal cannula or blow-by) | high_flow (>6 L/min, facemask, NRB, or Venturi) | positive_pressure (CPAP/BiPAP/intubation). Grade is the more severe of hypotension vs hypoxia: both none → 1 if fever or fever_waived else 0 (crs false); no_vasopressors or low_flow → 2; one_vasopressor or high_flow → 3; multiple_vasopressors or positive_pressure → 4. Organ toxicities do not influence grade. Not ICANS",
      "criteria": [
        {
          "factor": "fever_or_waived",
          "met": true
        },
        {
          "value": "none",
          "factor": "hypotension_none",
          "met": true
        },
        {
          "factor": "hypotension_no_vasopressors",
          "met": false
        },
        {
          "factor": "hypotension_one_vasopressor",
          "met": false
        },
        {
          "factor": "hypotension_multiple_vasopressors",
          "met": false
        },
        {
          "value": "none",
          "factor": "hypoxia_none",
          "met": true
        },
        {
          "factor": "hypoxia_low_flow",
          "met": false
        },
        {
          "factor": "hypoxia_high_flow",
          "met": false
        },
        {
          "factor": "hypoxia_positive_pressure",
          "met": false
        }
      ],
      "grade": 1,
      "crs": true,
      "fever": true,
      "fever_waived": false,
      "hypotension": "none",
      "hypotension_grade": 0,
      "hypoxia": "none",
      "hypoxia_grade": 0
    }
  ]
}
```

## Response fields

- `formula` (string): astct_crs
- `formula_expression` (string): Lee 2019 ASTCT CRS Table 1 fever, hypotension, and hypoxia grade rule
- `grade` (integer): ASTCT CRS grade 0, 1, 2, 3, or 4. More severe of hypotension vs hypoxia. Grade 0 is no CRS (both axes none without fever and without fever_waived). Grade 5 death is not returned. Not ICANS.
- `crs` (boolean): true iff grade ≥1. Not a CRS diagnosis.
- `fever` (boolean): Echo of caller-assigned fever (≥38°C not attributable to another cause)
- `fever_waived` (boolean): Echo of caller-assigned fever waiver after antipyretic, tocilizumab, or steroids
- `hypotension` (string): none, no_vasopressors, one_vasopressor, or multiple_vasopressors
- `hypoxia` (string): none, low_flow, high_flow, or positive_pressure
- `hypotension_grade` (integer): 0 if none, 2 if no_vasopressors, 3 if one_vasopressor, 4 if multiple_vasopressors
- `hypoxia_grade` (integer): 0 if none, 2 if low_flow, 3 if high_flow, 4 if positive_pressure
- `criteria` (array): Per-factor Tree rows with factor and met for fever_or_waived and each hypotension and hypoxia token
- `citation` (object): Lee 2019 Biol Blood Marrow Transplant ASTCT CRS citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Lee DW, Santomasso BD, Locke FL, Ghobadi A, Turtle CJ, Brudno JN, Maus MV, Park JH, Mead E, Pavletic S, Go WY, Eldjerou L, Gardner RA, Frey N, Curran KJ, Peggs K, Pasquini M, DiPersio JF, van den Brink MRM, Komanduri KV, Grupp SA, Neelapu SS",
    "doi": "10.1016/j.bbmt.2018.12.758",
    "id": "lee-2019",
    "pmid": "30592986",
    "source": "Biol Blood Marrow Transplant. 2019;25(4):625-638",
    "title": "ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells"
  },
  "formula": "astct_crs",
  "formula_expression": "Lee 2019 ASTCT CRS Table 1. fever is temperature ≥38°C not attributable to another cause. fever_waived true if CRS already treated with antipyretic/tocilizumab/steroids so fever is no longer required. hypotension none | no_vasopressors | one_vasopressor (with or without vasopressin) | multiple_vasopressors (excluding vasopressin). hypoxia none | low_flow (≤6 L/min nasal cannula or blow-by) | high_flow (>6 L/min, facemask, NRB, or Venturi) | positive_pressure (CPAP/BiPAP/intubation). Grade is the more severe of hypotension vs hypoxia: both none → 1 if fever or fever_waived else 0 (crs false); no_vasopressors or low_flow → 2; one_vasopressor or high_flow → 3; multiple_vasopressors or positive_pressure → 4. Organ toxicities do not influence grade. Not ICANS",
  "criteria": [
    {
      "factor": "fever_or_waived",
      "met": true
    },
    {
      "value": "none",
      "factor": "hypotension_none",
      "met": true
    },
    {
      "factor": "hypotension_no_vasopressors",
      "met": false
    },
    {
      "factor": "hypotension_one_vasopressor",
      "met": false
    },
    {
      "factor": "hypotension_multiple_vasopressors",
      "met": false
    },
    {
      "value": "none",
      "factor": "hypoxia_none",
      "met": true
    },
    {
      "factor": "hypoxia_low_flow",
      "met": false
    },
    {
      "factor": "hypoxia_high_flow",
      "met": false
    },
    {
      "factor": "hypoxia_positive_pressure",
      "met": false
    }
  ],
  "grade": 1,
  "crs": true,
  "fever": true,
  "fever_waived": false,
  "hypotension": "none",
  "hypotension_grade": 0,
  "hypoxia": "none",
  "hypoxia_grade": 0
}
```

## Errors

- HTTP 400 `invalid_astct_crs`: hypotension must be none, no_vasopressors, one_vasopressor, or multiple_vasopressors; hypoxia none, low_flow, high_flow, or positive_pressure (Lee 2019 ASTCT CRS Table 1). Returned before settlement; you are not charged.
- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

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## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.