One-year mortality of hematopoietic stem cell recipients admitted to an intensive care unit in a dedicated Brazilian cancer center
a retrospective cohort study
Keywords:
Critical care, Hematopoietic stem cell transplantation, Mortality, Bone marrow transplantation, Renal replacement therapyAbstract
BACKGROUND: Hematopoietic stem cell transplantation (HSCT) recipients requiring intensive care unit (ICU) admission early after transplantation have a poor prognosis. However, many studies have only focused on allogeneic HSCT recipients. OBJECTIVES: To describe the characteristics of HSCT recipients admitted to the ICU shortly after transplantation and assess differences in 1-year mortality between autologous and allogeneic HSCT recipients. DESIGN AND SETTING: A single-center retrospective cohort study in a cancer center in Brazil. METHODS: We included all consecutive patients who underwent HSCT less than a year before ICU admission between 2009 and 2018. We collected clinical and demographic data and assessed the 1-year mortality of all patients. The effect of allogeneic HSCT compared with autologous HSCT on 1-year mortality risk was evaluated in an unadjusted model and an adjusted Cox proportional hazard model for age and Sequential Organ Failure Assessment (SOFA) at admission. RESULTS: Of the 942 patients who underwent HSCT during the study period, 83 (8.8%) were included in the study (autologous HSCT = 57 [68.7%], allogeneic HSCT = 26 [31.3%]). At 1 year after ICU admission, 21 (36.8%) and 18 (69.2%) patients who underwent autologous and allogeneic HSCT, respectively, had died. Allogeneic HSCT was associated with increased 1-year mortality (unadjusted hazard ratio, HR = 2.79 [confidence interval, CI, 95%, 1.48–5.26]; adjusted HR = 2.62 [CI 95%, 1.29–5.31]). CONCLUSION: Allogeneic HSCT recipients admitted to the ICU had higher short- and long-term mortality rates than autologous HSCT recipients, even after adjusting for age and severity at ICU admission.
Downloads
References
Bazinet A, Popradi G. A general practitioner’s guide to hematopoietic stem-cell transplantation. Curr Oncol. 2019;26(3):187-91. PMID: 31285665; https://doi.org/10.3747/co.26.5033.
Fornwalt RA, Brigham EP, Scott Stephens R. Critical Care of Hematopoietic Stem Cell Transplant Patients. Crit Care Clin. 2021;37(1):29-46. PMID: 33190774; https://doi.org/10.1016/j.ccc.2020.08.002.
Lengliné E, Mirouse A, Azoulay E. Top ten tips for the management of critically ill hematopoietic stem cell transplantation recipients. Intensive Care Med. 2019;45(3):384-7. PMID: 30863937; https://doi.org/10.1007/s00134-019-05587-0.
Lengliné E, Chevret S, Moreau AS, et al. Changes in intensive care for allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transplantation. 2015;50(6):840-5. PMID: 25798675; https://doi.org/10.1038/bmt.2015.55.
Lueck C, Stadler M, Koenecke C, et al. Improved short- and long-term outcome of allogeneic stem cell recipients admitted to the intensive care unit: a retrospective longitudinal analysis of 942 patients. Intensive Care Med. 2018;44(9):1483-92. PMID: 30141173; https://doi.org/10.1007/s00134-018-5347-x.
Darmon M, Bourmaud A, Georges Q, et al. Changes in critically ill cancer patients’ short-term outcome over the last decades: results of systematic review with meta-analysis on individual data. Intensive Care Med. 2019;45(7):977-87. PMID: 31143998; https://doi.org/10.1007/s00134-019-05653-7.
Saillard C, Darmon M, Bisbal M, et al. Critically ill allogenic HSCT patients in the intensive care unit: a systematic review and meta-analysis of prognostic factors of mortality. Bone Marrow Transplantat. 2018;53(10):1233-41. PMID: 29703972; https://doi.org/10.1038/s41409-018-0181-x.
Kerhuel L, Amorim S, Azoulay E, Thiéblemont C, Canet E. Clinical features of life-threatening complications following autologous stem cell transplantation in patients with lymphoma. Leuk Lymphoma. 2015;56(11):3090-5. PMID: 25813206; https://doi.org/10.3109/10428 194.2015.1034700.
Jenkins P, Johnston LJ, Pickham D, et al. Intensive Care Utilization for Hematopoietic Cell Transplant Recipients. Biol Blood Marrow Transplant. 2015;21(11):2023-7. PMID: 26238809; https://doi.org/10.1016/j. bbmt.2015.07.026.
Trinkaus MA, Lapinsky SE, Crump M, et al. Predictors of mortality in patients undergoing autologous hematopoietic cell transplantation admitted to the intensive care unit. Bone Marrow Transplantat. 2009;43(5):411-5. PMID: 18936734; https://doi.org/10.1038/bmt.2008.336.
Barreto LM, Torga JP, Coelho SV, Nobre V. Main characteristics observed in patients with hematologic diseases admitted to an intensive care unit of a Brazilian university hospital. Rev Bras Ter Intensiva. 2015;27(3):212-9. PMID: 26331970; https://doi.org/10.5935/0103-507X.20150034.
Platon L, Amigues L, Ceballos P, et al. A reappraisal of ICU and long-term outcome of allogeneic hematopoietic stem cell transplantation patients and reassessment of prognosis factors: results of a 5-year cohort study (2009-2013). Bone Marrow Transplant. 2016;51(2):256-61. PMID: 26569092; https://doi.org/10.1038/bmt.2015.269.
Mokart D, Lambert J, Schnell D, et al. Delayed intensive care unit admission is associated with increased mortality in patients with cancer with acute respiratory failure. Leuk Lymphoma. 2013;54(8):1724-9. PMID: 23185988; https://doi.org/10.3109/10428194.2012.753446.
von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-9. PMID: 18313558; https://doi.org/10.1016/j.jclinepi.2007.11.008.
Metnitz PG, Moreno RP, Almeida E, et al. SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 1: Objectives, methods and cohort description. Intensive Care Med. 2005;31(10):1336-
PMID: 16132893; https://doi.org/10.1007/s00134-005-2762-6.
Moreno RP, Metnitz PG, Almeida E, et al. SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med. 2005;31(10):1345-55. PMID: 16132892; https://doi.org/10.1007/s00134-005-2763-5. Erratum in: Intensive Care Med. 2006;32(5):796.
Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707-10. PMID: 8844239; https://doi.org/10.1007/BF01709751.
Scales DC, Thiruchelvam D, Kiss A, Sibbald WJ, Redelmeier DA. Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis. Crit Care. 2008;12(3):R77. PMID: 18547422; https://doi.org/10.1186/cc6923.
Mokart D, Granata A, Crocchiolo R, et al. Allogeneic hematopoietic stem cell transplantation after reduced intensity conditioning regimen: Outcomes of patients admitted to intensive care unit. J Crit Care. 2015;30(5):1107-13. PMID: 26193780; https://doi.org/10.1016/j. jcrc.2015.06.020.
Orvain C, Beloncle F, Hamel JF, et al. Allogeneic stem cell transplantation recipients requiring intensive care: time is of the essence. Ann Hematol. 2018;97(9):1601-9. PMID: 29717367; https://doi.org/10.1007/s00277-
- 3320-y.
Galindo-Becerra S, Labastida-Mercado N, Rosales-Padrón J, et al. Outcome of Recipients of Hematopoietic Stem Cell Transplants Who Require Intensive Care Unit Support: A Single Institution Experience. Acta Haematol. 2015;134(2):119-24. PMID: 25925695; https://doi. org/10.1159/000381301.
Huynh TN, Weigt SS, Belperio JA, Territo M, Keane MP. Outcome and prognostic indicators of patients with hematopoietic stem cell transplants admitted to the intensive care unit. J Transplant. 2009;2009:917294. PMID: 20130763; https://doi.org/10.1155/2009/917294.
Yadav H, Nolan ME, Bohman JK, et al. Epidemiology of Acute Respiratory Distress Syndrome Following Hematopoietic Stem Cell Transplantation. Crit Care Med. 2016;44(6):1082-90. PMID: 26807683; https://doi. org/10.1097/CCM.0000000000001617.
Nakamura M, Fujii N, Shimizu K, et al. Long-term outcomes in patients treated in the intensive care unit after hematopoietic stem cell transplantation. Int J Hematol. 2018;108(6):622-9. PMID: 30238198; https://doi.org/10.1007/s12185-018-2536-x.
