Management of hematological patients requiring emergency chemotherapy in the intensive care unit
Antoine Lafarge, Dara Chean, Livia Whiting, Raphaël Clère-Jehl, Groupe de Recherche en Réanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH), Élie Azoulay, Djamel Mokart, Virginie Lemiale, Laurent Argaud, Dominique Benoît, Naïke Bigé, Magali Bisbal, Emmanuel Canet, Fabrice Bruneel, Alexandre Demoule, Achille Kouatchet, Julien Mayaux, Anne‐Sophie Moreau, Saad Nseir, Martine Nyunga, Frédéric Pène, Amélie Seguin, Lara Zafrani, Olfa Hamzaoui, Bruno Mourvillier, Pierre Asfar, David Schnell, Gaëtan Plantefève, Julio Badié, Nicholas Sedillot, Xavier Wittebole, Jean‐Paul Mira, Jean‐Philippe Rigaud, Pierre-Louis Declercq, Jean‐Pierre Quenot, Frédéric Forêt, Djillali Annane, Nicholas Heming, Pierre Bulpa, Patrick M. Honoré, Raphaël Clere-Jehl, Francis Schneider, Jean-Claude Lachérade, Gwenhaël Colin, Christophe Guitton, Olivier Nigeon, Nicolas Van Grunderbeeck, Bruno François, Christophe Guervilly, Mehran Monchi, Jérôme Roustan, Jean Reignier, Ferhat Meziani, Julie Helms, François Barbier, Toufik Kamel, Grégoire Müller, Nicolas De Schryver, Jean‐Pierre Frat, Delphine Chatelier, Nicolas Barbarot, François Legay, Charles Vidal, Laurence Dangers, Emmanuelle Mercier, Stéphan Ehrmann, Juliette Audibert, Asaël Berger, David Joganah, Jonathan Chelly, Laurent Ducros, Florian Reizine, Agathe Delbove, Florent Bavozet, Paul-Simon Pugliesi, Thomas Maldiney, Shidasp Siami, Jean‐François Timsit, Pierre Tissières, Sébastien Gibot, Éric Maury
Abstract
Hematological malignancies may require rapid-onset treatment because of their short doubling time, notably observed in acute leukemias and specific high-grade lymphomas. Furthermore, in targeted onco-hematological scenarios, chemotherapy is deemed necessary as an emergency measure when facing short-term, life-threatening complications associated with highly chemosensitive hematological malignancies. The risks inherent in the disease itself, or in the initiation of treatment, may then require admission to the intensive care unit (ICU) to optimize monitoring and initial management protocols. Hyperleukocytosis and leukostasis in acute leukemias, tumor lysis syndrome, and disseminated intravascular coagulation are the most frequent onco-hematological complications requiring the implementation of emergency chemotherapy in the ICU. Chemotherapy must also be started urgently in secondary hemophagocytic lymphohistiocytosis. Tumor-induced microangiopathic hemolytic anemia and plasma hyperviscosity due to malignant monoclonal gammopathy represent infrequent yet substantial indications for emergency chemotherapy. In all cases, the administration of emergency chemotherapy in the ICU requires close collaboration between intensivists and hematology specialists. In this review, we provide valuable insights that aid in the identification and treatment of patients requiring emergency chemotherapy in the ICU, offering diagnostic tools and guidance for their overall initial management.