Intensive Care Outcomes of Patients after High Dose Chemotherapy and Subsequent Autologous Stem Cell Transplantation: A Retrospective, Single Centre Analysis

Abstract

High dose chemotherapy (HDT) followed by autologous peripheral blood stem cell transplantation (ASCT) is standard of care including a curative treatment option for several cancers. While much is known about the management of patients with allogenic SCT at the intensive care unit (ICU), data regarding incidence, clinical impact, and outcome of critical illness following ASCT are less reported. This study included 256 patients with different cancer entities. Median age was 56 years (interquartile ranges (IQR): 45–64), and 67% were male. One-year survival was 89%; 15 patients (6%) required treatment at the ICU following HDT. The main reason for ICU admission was septic shock (80%) with the predominant focus being the respiratory tract (53%). Three patients died, twelve recovered, and six (40%) were alive at one-year, resulting in an immediate treatment-related mortality of 1.2%. Independent risk factors for ICU admission were age (odds ratio (OR) 1.05; 95% confidence interval (CI) 1.00–1.09; p = 0.043), duration of aplasia (OR: 1.37; CI: 1.07–1.75; p = 0.013), and Charlson comorbidity score (OR: 1.64; CI: 1.20–2.23; p = 0.002). HDT followed by ASCT performed at an experienced centre is generally associated with a low risk for treatment related mortality. ICU treatment is warranted mainly due to infectious complications and has a strong positive impact on intermediate-term survival.

Characteristics and outcomes of patients undergoing high-dose chemotherapy and autologous stem cell transplantation admitted to the intensive care unit: a single-center retrospective analysis

“…The median SOFA score at admission to the ICU was 7. These results are in line with an earlier report from Germany indicating that sepsis was the cause for ICU admission in 67% of cases; the median SOFA score at admission to the ICU was 8 [ 7 ]. In contrast, analyses addressing the outcome of individuals admitted to the ICU early after allogeneic stem cell transplantation revealed higher median SOFA scores up to 14 reflecting more severe illness in these patients [ 13 – 15 ].…”

“…According to an older retrospective study from Canada including patients treated with high-dose chemotherapy and ASCT between 2001 and 2006, the ICU admission rate was 3.3%. The median age of patients included in the present analysis was comparable to the previous reports (64 years and 57 years, respectively), whereas the proportion of females was lower than in the earlier studies (47% and 53%, respectively) [ 7 , 8 ]. The higher ICU admission rate in the present analysis may at least in part be due to the more recent advent of data suggesting an improved OS for critically ill patients with hematologic malignancies who were admitted to the ICU early [ 12 ].…”

“…Data on characteristics and course of patients who had high-dose chemotherapy followed by ASCT and were admitted to the ICU are scarce [ 7 – 9 ]. This is especially true for individuals in whom ICU admission occurred during conditioning therapy or early after ASCT.…”

Von der Knochenmarktransplantation zur Intensive Care Unit – Critical Care Report

“…In einer aktuellen retrospektiven Studie wurde bei 256 autolog transplantierten Patienten nach ICU-Aufnahme eine Überlebensrate von 86 % beobachtet. Hauptaufnahmegrund war septischer Schock (Karagiannis et al, 2020).…”

Characteristics and outcomes of patients with acute myeloid leukemia admitted to intensive care unit with acute respiratory failure: a post-hoc analysis of a prospective multicenter study

“…Acute respiratory failure (ARF) is the leading cause of ICU admission in patients with AML [5] and its management is challenging, because of the unique features that ARF could display in this context [6][7][8]. In recent years, an increasing number of immunocompromised patients are being admitted to ICUs, with improved survival compared to the past [9][10][11], and a relevant proportion of them is represented by AML patients with ARF who need prompt critical management [12][13][14]. Moreover, these patients show a complex type of immunosuppression, depending on the disease phase and on the treatment administered, and these factors are to consider in their management; at diagnosis, AML immunosuppression is mostly related to the hematological malignancy (e.g., hyperleukocytosis with functional neutropenia) [15], while, after hematopoietic stem cell transplantation, immunosuppression is mainly related to cellular immune-modulation and immune-reconstitution [16].…”