Admission of Hematopoietic Cell Transplantation Patients to the Intensive Care Unit at the Pontificia Universidad Católica de Chile Hospital

Abstract

Patients undergoing hematopoietic cell transplantation (HCT) can have complications that require management in the intensive care unit (ICU). We conducted a retrospective study of patients undergoing HCT between 2007 and 2011 with admission to the ICU. We analyzed 97 patients, with an average age of 37 (range, 15 to 68). The main indications for HCT were hematologic malignancies (84%, n = 82). Ninety percent (n = 87) received myeloablative conditioning. Thirty-one percent were admitted (autologous transplant recipients 15%, allogeneic transplant recipients 34%, and umbilical cord blood [UCB] transplant recipients 48%) with an average length of stay of 19 days (range, 1 to 73 days). The average time between transplantation and transfer was 15 days. The main causes of admission were acute respiratory failure (63%) and septic shock (20%). ICU mortality was 20% for autologous transplantations and 64% for allogeneic transplantations (adult donor and UCB combined). On average, patients died 108 days after the transplantation (range, 4 to 320 days). One-year overall survival, comparing patients entering the ICU with those never admitted, was 16% versus 82% (P < .0001) for allogeneic transplantations (adult donor and UCB combined) and 80% versus 89% (P = not significant) for autologous transplantations. Acute graft-versus-host disease was significantly associated with death in ICU after UCB HCT. ICU support is satisfactory in about one half of patients admitted, characterized by a short and medium term prognosis not as unfavorable as has been previously reported.

The Changing Pattern of Admission of Allograft Patients to the Intensive Care Unit

“…RIC is endowed with more late complications or relapses than myeloablative allografting, and the timing of these complications may also be related to the differences observed between the groups reported from Denmark and Mexico. Even though the in-hospital mortality rate was higher in the Mexican group, the 1-year overall survival was better in the patients from Mexico and similar to that reported from Chile [5], another developing country. …”

Outcome of Recipients of Hematopoietic Stem Cell Transplants Who Require Intensive Care Unit Support: A Single Institution Experience

“…A paper dealing with ICU admission after HSCT in a developing country (Chile) has been recently published [25] . Interestingly, the need to admit transplanted patients was in agreement with our experience (15% of autografts and 34% of allografts in their experience vs. 11 and 27%, respectively, in ours).…”

Critical care of patients with cancer

“…More recently, their survival has improved, but mortality still remains high . The reported hospital mortality of patients in studies that were published after 2010 is in the range from 63% to 83% . Long‐term survival is uniformly poor, with reported 1‐year survival rates in recent publications ranging from 15% to 19% .…”

“…[130][131][132][133] The reported hospital mortality of patients in studies that were published after 2010 is in the range from 63% to 83%. 127,131,[134][135][136][137] Long-term survival is uniformly poor, with reported 1-year survival rates in recent publications ranging from 15% to 19%. 131,134,138 Of note, a British retrospective, single-center study demonstrated that, despite the poor outcome of critically ill allogeneic stem cell transplantation recipients, those patients who did survive the ICU stay achieved impressive 1-year and 5-year survival rates of 61% and 51%, respectively, that were equivalent to those of transplant recipients who did not require ICU admission.…”