Cytokine release syndrome (CRS) and Immune effector Cell-Associated Neurotoxicity Syndrome (ICANS) after Chimeric antigen receptor (CAR) T cell treatment are common, and severe CRS (sCRS) could be life threatening. IL-6 receptor antibody and steroid are recommended for CRS, but no clear strategies exist for steroid-resistant sCRS. Thus, this study reported a case of resistance to tocilizumab and pulse therapy of methylprednisolone while suffering from grade 4 CRS and ICANS. After plasma exchange for two times and continuous renal replacement treatment combined with ruxolitinib, the patient survived with only renal injury, and achieved complete remission with negative minimal residual disease.