Critically ill allogenic HSCT patients in the intensive care unit: a systematic review and meta-analysis of prognostic factors of mortality

Abstract

Outcome of patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT) has improved. To investigate if this improvement can be transposed to the ICU setting, we conducted a systematic review and meta-analysis to assess short-term mortality of critically ill allo-HSCT patients admitted to the ICU and to identify prognostic factors of mortality. Public-domain electronic databases, including Medline via PubMed and the Cochrane Library were searched. All full-text articles written-English studies published from 2006 to 2016, including allo-HSCT adults transferred to the ICU were included. Eighteen studies were selected, including 2342 patients. Overall estimated ICU mortality was 51.7%. Prognostic factors associated with an increased ICU mortality were mechanical ventilation (OR = 12.2, 95% CI = 6.2-23.7), vasopressors (OR = 6.3, 95% CI = 3.6-11.1), renal replacement therapy (OR = 4.2, 95% CI = 2.8-6.2), ICU admission for acute respiratory failure (OR = 2.2, 95% CI = 1.1-4.4), acute kidney injury (OR = 2.2, 95% CI = 1.3-4), and acute graft-versus-host disease (OR = 1.6, 95% CI = 1.1-2.3). Factors associated with an increased ICU survival were a single-organ failure (OR = 0.2, 95% CI = 0.1-0.4), neurological failure (OR = 0.4, 95% CI = 0.2-0.8), and reduced-intensity conditioning regimens (OR = 0.7, 95% CI = 0.5-0.9). Septic shock, underlying malignancy, disease status, donor, and graft source did not impact prognosis. Outcome has improved, supporting the usefulness of ICU management. Organ failures at ICU admission, organ support requirement, and GVHD are the main prognostic factors.

Candidemia in critically ill immunocompromised patients: report of a retrospective multicenter cohort study

“…The only exception is the peculiar population of allogeneic stem cell transplant recipients. These data are concordant with the poor prognosis of critically ill allogeneic stem cell transplant recipients, in whom a mortality of 51% was described, rising to 71% when mechanical ventilation was needed [19]. In this cohort, allogeneic stem cell transplant recipients with candidemia had a hospital mortality of 88%.…”

Short‐ and long‐term outcomes of neutropenic cancer patients in intensive care according to requirement for invasive ventilation

“…In line with previous studies, underlying malignancy type was not associated with prognosis at ICU discharge . However, in contrast to other, contemporaneous studies, neutropenia as a result of chemotherapy or recent HSCT was associated with improved ICU survival. In neutropenic patients requiring IMV following recent HSCT, traditionally considered to have unacceptably high risk of mortality, both short‐ and long‐term mortality was superior to the cohort average.…”

G‐CSF administration prior to donor lymphocyte apheresis promotes anti‐leukaemic effects in allogeneic HCT patients

“…In addition, occurrence of chronic GVHD after DLI was associated with a significantly improved survival. We and others found in previous studies that limited forms of GVHD were associated with favourable graft‐versus‐tumour effects and improved survival, whereas severe GVHD outweighed such benefits by higher GVHD‐related morbidity and mortality (Introna et al , ; Miyamoto et al , ; Tan et al , ; Saillard et al , ; Schneidawind et al , ).…”