Improved intensive care unit survival for critically ill allogeneic haematopoietic stem cell transplant recipients following reduced intensity conditioning

Abstract

The use of allogeneic haematopoietic stem cell transplantation (Allo-HSCT) is a standard treatment option for many patients with haematological malignancies. Historically, patients requiring intensive care unit (ICU) admission for transplant-related toxicities have fared extremely poorly, with high ICU mortality rates. Little is known about the impact of reduced intensity Allo-HSCT conditioning regimens in older patients on the ICU and subsequent long-term outcomes. A retrospective analysis of data collected from 164 consecutive Allo-HSCT recipients admitted to ICU for a total of 213 admissions, at a single centre over an 11·5-year study period was performed. Follow-up was recorded until 31 March 2011. Autologous HSCT recipients were excluded. In this study we report favourable ICU survival following Allo-HSCT and, for the first time, demonstrate significantly better survival for patients who underwent Allo-HSCT with reduced intensity conditioning compared to those treated with myeloablative conditioning regimens. In addition, we identified the need for ventilation (invasive or non-invasive) as an independently significant adverse factor affecting short-term ICU outcome. For patients surviving ICU admission, subsequent long-term overall survival was excellent; 61% and 51% at 1 and 5 years, respectively. Reduced intensity Allo-HSCT patients admitted to ICU with critical illness have improved survival compared to myeloablative Allo-HSCT recipients.

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

“…67,70,71 The need for ventilatory support ranges from 28 to 76% in recent studies, 13,16,21,24,25,[27][28][29][30][31][32][33][34][35] and ICU mortality varies from 63 to 85% (Table 3). These results are far worse than the respective 70% and 62% ICU and hospital survival rates reported in a large observational study of unselected ICU patients requiring MV.…”

“…This thematic represents a great investigational field. Acute renal failure at ICU admission is an adverse prognostic factor 20,33,34 as is the use of renal replacement therapy. 24,29,32 Allo-HSCT recipients are known to be at high risk for AKI as they are often exposed to Critically ill allogeneic HSCT patients in the ICU C Saillard et al combinations of various aggressions.…”

Mortalidade relacionada ao transplante e fatores associados em pacientes submetidos ao transplante de células tronco hematopoiéticas: estudo de coorte

“…Na atualidade, dada a semelhança entre pacientes de UTI e aqueles de TCTH, em termos de gravidade, muitos autores têm utilizado o SAPS e o EBMT nos estudos epidemiológicos (9,10,37,44,(48)(49)(50) a fim de caracterizar os pacientes em termos de gravidade da doença e avaliar a qualidade da assistência, os riscos e a MRT no TCTH (4,14,38,39,41,47,48,(51)(52)(53)(54)(55)(56)(57) .…”

“…No TCTH, a MRT em diferentes países varia de 2% a 85% (9,10,39,51,(54)(55)(56)(57)(58) . A probabilidade de sobrevida, de um a cinco anos, identificada por escore de risco pré-TCTH do EBMT, varia de 10,5% a 60% (4,9,39,41,51,58,59) .…”

“…Nas UTI em que o uso do SAPSII é frequente, estima-se que 20 a 40% dos pacientes submetidos a TCTH autólogo e alogênico necessitem de cuidados intensivos (63) e cuja taxa de mortalidade hospitalar varia de 54-96% (55,64) .…”