Outcome of adult umbilical cord blood transplant patients admitted to a medical intensive care unit

Abstract

Umbilical cord blood transplant (UCBT) has emerged as an alternate source of stem cells for transplantation in patients with hematologic malignancies. However, outcomes of adult UCBT patients requiring ICU admission remain unknown. In order to identify predictors of ICU transfer and mortality in UCBT patients, the course and outcome of all adult (X16 years old) patients who underwent UCBT between 1 January 1998 and 31 December 2003 at University Hospitals of Cleveland were analyzed. Fortyfour patients underwent UCBT during the study period and 25 (57%) required ICU transfer. Use of a myeloablative preparative regimen was a significant predictor of ICU transfer (P ¼ 0.03). An infusion of higher numbers of nucleated cells was protective from ICU transfer (P ¼ 0.05). For those patients transferred to the ICU, mortality was 72%. The univariate predictors of mortality, at the time of ICU admission were a high APACHE III score (P ¼ 0.0004), use of vasopressors (P ¼ 0.03), and a low platelet count (P ¼ 0.03). We conclude that transfer of UCBT patients to an ICU may be predicted by their preparative regimen, while ICU mortality may be predicted by physiologic parameters upon admission.

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

“…19,[26][27][28]31 Neurological failure at admission was associated with a better hospital survival, probably because most of the patients presented a reversible cause. 30 Hepatic failure represents a major issue for the next years, with bilirubin level being associated with an adverse 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.…”

“…10,24 MOF at ICU admission appears as the main prognostic factor, especially when MV is required with almost a 100% mortality rate, 13 and no progress has been accomplished in the past decade in this situation. 20,24 Severity scores reflecting organ dysfunctions, such as APACHE II, APACHE III, SOFA and SAPSII, can help in severity assessment 19,24,30,31 but have not been validated in allo-HSCT patients.…”

Intensive care outcomes in adult hematopoietic stem cell transplantation patients

“…Naeem et al [14] reported an ICU admission rate of 57% among patients who received umbilical cord blood grafts. However, the advent of double-cord blood transplants has improved the immune recovery since that study was published; the ICU admission rate after cord blood transplants is very likely lower now.…”

“…In cohorts including only AlloSCT patients, ICU admission rates have been consistently reported to range between 9%-20% [8][9][10][11][12] with only two outliers [13,14] .…”