Advances in the critical care management for patients with hematological malignancies

Clinical Snapshot

Key Findings

• Effect Size: Not quantified - narrative synthesis

• Primary Outcome: Improved survival rates in critically ill hematology patients with modern management approaches

• Nnt Or Sensitivity: Early ICU admission and multidisciplinary care identified as key interventions

Clinical Application

High feasibility in tertiary centres with hematology-oncology services Relevant to Australian ICUs managing complex hematology patients; aligns with ANZICS guidelines for cancer patient care; considerations for PBS-funded novel therapies like CAR-T cells Australian patients with hematological malignancies requiring ICU care

Abstract

Hematological malignancies (HMs) are increasingly associated with life-threatening complications requiring intensive care unit (ICU) management. Recent advancements in therapies, diagnostics, and critical care protocols have improved outcomes for these patients, yet significant challenges persist. This manuscript explores the evolving landscape of critical care in hematology, emphasizing the unique complications, management strategies, and future directions in the field. Patients with HMs are particularly vulnerable to infections, sepsis, organ dysfunction, and treatment-related toxicities such as cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and coagulopathies. Innovations in the management of acute respiratory failure, septic shock, and invasive fungal infections have contributed to better survival rates, yet outcomes remain suboptimal for certain high-risk groups. Furthermore, new therapies, including CAR-T cells, bispecific antibodies, and immune checkpoint inhibitors, present both opportunities and challenges in the ICU setting due to their potential toxicities. Emerging trends emphasize the importance of early ICU admission, multidisciplinary collaboration, and precision medicine in improving patient care. The integration of biomarker-driven strategies, advanced diagnostics, and artificial intelligence holds promise for optimizing therapeutic interventions and enhancing antimicrobial stewardship. Additionally, patient-centered approaches, including time-limited trials and goal-oriented discussions, aim to balance aggressive care with quality-of-life considerations. This review underscores the need for continued research to address disparities in access to care, improve long-term outcomes, and develop standardized protocols for managing critically ill hematology patients. By advancing the integration of oncology and critical care, clinicians can better navigate the complexities of modern therapies and provide holistic, evidence-based care that aligns with patient values and priorities.

References

1. 1.Azoulay, E., Zafrani, L., Nates, J., Maillard, A., Chean, D., Ferreyro, B., Nelson, J. E., Bauer, P. R., Puxty, K., Gutierrez, C., Bigé, N., Mariotte, E., Valade, S., Boell, B., Puntillo, K., Lafarge, A., Soares, M., Schellongowski, P., Canet, E., Castro, P., Demoule, A., Pène, F., Munshi, L., Shimabukuro-Vornhagen, A., Staudinger, T., Russell, L., Fernandez, S., Kochanek, M., Lemiale, V., von Bergwelt-Baildon, M., Darmon, M., & Martin-Loeches, I. (2025). Advances in the critical care management for patients with hematological malignancies. Blood Reviews, 101306. https://doi.org/10.1016/j.blre.2025.101306