Adverse Events of Novel Therapies for Hematologic Malignancies: What Emergency Physicians Should Know

Area of Science:

• Hematology and Oncology
• Emergency Medicine
• Pharmacology

Background:

• Significant advancements in hematologic malignancy therapeutics have occurred in the last decade.
• The Food and Drug Administration approved over two dozen novel agents between 2014 and 2018.
• Emergency medicine literature and guidelines have not kept pace with rapid oncology advances.

Purpose of the Study:

• To review recent, clinically relevant developments in hematologic malignancies.
• To expand on drug toxicities, their clinical presentations, and management strategies.
• To raise awareness among emergency health care providers regarding novel cancer therapeutic toxicities.

Main Methods:

• Review of recent literature on novel agents and their toxicities in hematologic malignancies.
• Discussion of specific immune-related adverse events and other acute toxicities.
• Provision of suggestions for the recognition and management of these conditions.

Main Results:

• Novel cancer therapeutics present unique and acute toxicities requiring prompt recognition.
• Specific toxicities discussed include immune-related adverse events (myocarditis, hemophagocytic lymphohistiocytosis), cytokine release syndrome, CAR T-cell-related encephalopathy syndrome, differentiation syndrome, sinusoid occlusion syndrome, QT-interval prolongation, and tumor lysis syndrome.
• Management strategies for these emerging oncologic emergencies are presented.

Conclusions:

• Rapid advancements in hematology and oncology pose significant challenges for emergency care.
• Familiarity with novel drug toxicities and their management is crucial for emergency physicians.
• Proactive awareness and education are essential to address the growing complexities of cancer therapeutics in emergency settings.