Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX.
Ann Emerg Med. 2020 Feb;75(2):264-286. doi: 10.1016/j.annemergmed.2019.07.015. Epub 2019 Sep 24.
In the past decade, rapid advances in therapeutic target discovery in hematologic malignancies have led to many clinical studies demonstrating efficacy of novel agents. Between 2014 and 2018, Food and Drug Administration approvals of new drugs and agents have increased, with greater than 2 dozen novel agents. Rapidly identifying the risk profiles of these cancer therapeutics that may present with acute toxicities and understanding the timing, sequence, duration, and treatment of disease processes are the most important challenges faced by practitioners in emergency medicine, even in nononcologic centers. The emergency medicine literature lags behind rapid advances in oncology, and guidelines for rapid recognition and management of these emerging entities are not familiar. In this Review Article, we discuss the most recent and clinically relevant developments in the arena of hematologic malignancies, further expanding on drug toxicities and their clinical presentations and offering suggestions for management. Specifically, we discuss immune-related adverse events after immune checkpoint inhibitor therapy (including myocarditis and hemophagocytic lymphohistiocytosis), chimeric antigen receptor-T cell therapy, cytokine release syndrome, chimeric antigen receptor-T cell-related encephalopathy syndrome, differentiation syndrome, sinusoid occlusion syndrome, QT-interval prolongation, and tumor lysis syndrome. Rapid advances in hematology and oncology will bring many new challenges for emergency health care providers in the near future; thus, the urgency to raise awareness among this community.
在过去的十年中，血液系统恶性肿瘤治疗靶点的快速发现导致了许多临床研究证明了新型药物的疗效。在 2014 年至 2018 年期间，美国食品和药物管理局批准了新的药物和制剂，其中有 20 多种新型制剂。快速识别这些癌症治疗药物的风险特征，这些药物可能会出现急性毒性，并了解疾病过程的时间、顺序、持续时间和治疗，是急诊医学从业者面临的最重要的挑战，即使在非肿瘤中心也是如此。急诊医学文献落后于肿瘤学的快速发展，对于这些新出现的实体的快速识别和管理的指南并不熟悉。在这篇综述文章中，我们讨论了血液系统恶性肿瘤领域最新和最具临床相关性的进展，进一步扩展了药物毒性及其临床表现，并就管理提供了建议。具体来说，我们讨论了免疫检查点抑制剂治疗后的免疫相关不良事件（包括心肌炎和噬血细胞性淋巴组织细胞增生症）、嵌合抗原受体-T 细胞治疗、细胞因子释放综合征、嵌合抗原受体-T 细胞相关脑病综合征、分化综合征、窦阻塞综合征、QT 间期延长和肿瘤溶解综合征。血液学和肿瘤学的快速发展将在不久的将来给急诊医疗保健提供者带来许多新的挑战；因此，提高这一群体的意识迫在眉睫。
