How do you manage severe cytarabine syndrome in AML patients, manifesting as severe hypotension, fevers, rash, and myalgias?

The cytarabine syndrome is a well-described (Castleberry et al. (1981) Medical and Pediatric Oncology 9:257) syndrome mediated by pro-inflammatory cytokines that are associated with fever, hypotension, rash, and often renal failure. In my experience, its most severe manifestations occur when a patient has active leukemia, i.e., during induction, as opposed to consolidation, and is more common when the cytarabine is given in an infusional fashion. When a new AML patient is initiated on infusional cytarabine, I watch for signs such as high fever, fluid retention, increased creatinine, and hypoxia. While infections must always be watched for in such circumstances (and usually empirically treated with broad spectrum antibiotics), I am usually q...