How I treat hematologic emergencies in adults with acute leukemia Journal Article
| Authors: | Zuckerman, T.; Ganzel, C.; Tallman, M. S.; Rowe, J. M. |
| Article Title: | How I treat hematologic emergencies in adults with acute leukemia |
| Abstract: | Acute myeloid leukemia and acute lymphoblastic leukemia remain devastating diseases. Only approximately 40% of younger and 10% of older adults are long-term survivors. Although curing the leukemia is always the most formidable challenge, complications from the disease itself and its treatment are associated with significant morbidity and mortality. Such complications, discussed herein, include tumor lysis, hyperleukocytosis, cytarabine-induced cellebellar toxicity, acute promyelocytic leukemia differentiation syndrome, thrombohemorrhagic syndrome in acute promyelocytic leukemia, L-asparaginase-associated thrombosis, leukemic meningitis, neutropenic fever, neutropenic enterocolitis, and transfussion-associated GVHD. Whereas clinical trials form the backbone for the management of acute leukemia, emergent clinical situations, predictable or not, are common and do not readily lend themselves to clinical trial evaluation. Furthermore, practice guidelines are often lacking. Not only are prospective trials impractical because of the emergent nature of the issue at hand, but clinicians are often reluctant to randomize such patients. Extensive practical experience is crucial and, even if there is no consensus, management of such emergencies should be guided by an understanding of the underlying pathophysiologic mechanisms. © 2012 by The American Society of Hematology. |
| Keywords: | adult; middle aged; acute granulocytic leukemia; leukemia, myeloid, acute; prednisone; fatigue; review; drug efficacy; drug safety; antineoplastic agents; cytarabine; drug megadose; low drug dose; kidney failure; acute lymphoblastic leukemia; coughing; drug fever; dyspnea; febrile neutropenia; hyperuricemia; tumor lysis syndrome; arsenic trioxide; hyperkalemia; acute leukemia; neutrophil; disease progression; thrombosis; practice guidelines as topic; promyelocytic leukemia; blood transfusion; graft versus host reaction; thrombocyte count; single drug dose; asparaginase; precursor cell lymphoblastic leukemia-lymphoma; pleura effusion; thorax radiography; leukocyte count; disease management; acute lymphocytic leukemia; corticosteroid; leukemia relapse; blood clotting disorder; erythrocyte transfusion; hemodialysis; leukocytosis; ataxia; retinoic acid; diet restriction; lung infiltrate; induction chemotherapy; low molecular weight heparin; hypocalcemia; hematocrit; urine volume; thrombophilia; randomized controlled trial (topic); nystagmus; allopurinol; leukapheresis; gait disorder; individualized medicine; dysarthria; acute lung injury; rasburicase; corticosteroid therapy; multicenter study (topic); glucose 6 phosphate dehydrogenase deficiency; hyperphosphatemia; hyperleukocytosis; neutropenic enterocolitis; emergencies; alkalinization; asymptomatic disease; leukemic meningitis; phosphate binding agent; continuous hemofiltration; leukostasis; lymphoblast |
| Journal Title: | Blood |
| Volume: | 120 |
| Issue: | 10 |
| ISSN: | 0006-4971 |
| Publisher: | American Society of Hematology |
| Date Published: | 2012-09-06 |
| Start Page: | 1993 |
| End Page: | 2002 |
| Language: | English |
| DOI: | 10.1182/blood-2012-04-424440 |
| PROVIDER: | scopus |
| PUBMED: | 22700723 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 October 2012" - "CODEN: BLOOA" - "Source: Scopus" |
