Role of the intensive care in treatment of patients with acute myeloid leukemia

Bazhenov, Aleksei; Galstyan, G. M.; Паровичникова, Е Н; Troitskaya, Vera V.; Кузьмина, Л А; Fidarova, Zalina; Грибанова, Е О; Makhinya, Sergei; Latyshkevich, O.A.; Chabaeva, U A; Kulikov, Sergey; Vg, Savchenko

doi:10.26442/00403660.2019.07.000321

Terapevticheskii arkhiv

2019

DOI: 10.26442/00403660.2019.07.000321

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Role of the intensive care in treatment of patients with acute myeloid leukemia

Aleksei Bazhenov¹,

G. M. Galstyan²,

Е Н Паровичникова³

et al.

Abstract: Aim. Remission induction can be associate, with the life threatening complications and transfer to ICU of de novo acute myeloid leukemia (AML) patients (pts). We evaluate influence of transfer to ICU and life threatening complication on early mortality and long - tram survival of de novo AML pts. Materials and methods. Retrospective study. All de novo AML pts younger than 60 years old admitted in the National Research Center for Hematology from 2013 to 2016 years were enrolled in the study. Patients were divid… Show more

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2022

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Role of the intensive care in allogeneic hematopoietic stem cell transplantation

Shchekina¹,

Galstyan²,

Drokov³

2022

Gematologiâ i transfuziologiâ

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Introduction. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is often complicated by life-threatening conditions.Aim — an analysis of the life-threatening complications in recipients of allogeneic hematopoietic stem cells (allo-HSCs)Main findings. From 10 to 50 % of allo-HSC recipients need to be admitted to the intensive care unit (ICU) due to the development of life-threatening complications. The reasons for ICU admission are acute respiratory failure, sepsis, graft-versus-host disease, veno-occlusive disease, thrombotic microangiopathy, cytokine release syndrome, engraftment syndrome, etc. Conditioning regimen, donor type, stem cell source, underlying disease state and patient comorbidity are the risk factors associated with development of life-threatening conditions. The main prognostic factors of unfavorable ICU outcomes in allo-HSC recipients are the severity of multiple organ dysfunction and the need for organ support.

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Role of the intensive care in allogeneic hematopoietic stem cell transplantation

Shchekina¹,

Galstyan²,

Drokov³

2022

Gematologiâ i transfuziologiâ

View full text Add to dashboard Cite

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Intensive care of life-threatening complications in allogeneic hematopoietic stem cell recipients

Shchekina¹,

Galstyan²,

Drokov³

et al. 2022

Gematologiâ i transfuziologiâ

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Introduction. Life-threatening complications of allogeneic hematopoietic stem cell transplantation (allo-HSCT) can have a signiﬁcant inﬂuence on the short-term and long-term prognosis in recipients of hematopoietic stem cells (allo-HSCs).Aim — to determine the life-threatening complications and the risk factors of their occurrence and to evaluate the short-term and long-term prognosis in critically ill allo-HSCs recipients.Materials and methods. All patients over the age of 18 who underwent allo-HSCT from 01.01.2012 to 01.01.2022 were included in the retrospective study. Patients were divided into two groups: those who required intensive care unit (ICU) admission and those who did not require ICU admission. In the group of ICU admitted allo-HSCs recipients the reasons of ICU admission, timing of their occurrence and the results of life support were recorded. The risk factors of life-threatening complications occurrence and prognostic factors were analyzed.Results. In total, 174 (26.7 %) of 652 allo-HSCs recipients required ICU admission. The risk factors of life-threatening complications were: allo-HSCT in patients with acute leukemia who did not achieve complete remission (hazard ratio (HR) = 2.10; 95 % conﬁdence interval (95% CI): 1.28–3.44; p = 0.003), allo-HSCT without conditioning in patients with hematopoietic aplasia after chemotherapy (HR = 30.63; 95% CI: 8.787–107.04; p < 0.001), graft failure (HR = 2.51; 95% CI: 1.58–3.97; p < 0.001) and poor graft function (HR = 2.85; 95% CI: 1.6–5.05; p < 0.001), acute graft versus host disease (GVHD) (HR = 2.04; 95% CI: 1.459–2.85; p < 0.001). The main reasons of ICU admission were sepsis and/or septic shock (SS) (27.9 %), acute respiratory failure (23.9 %), neurological disorders (17.7 %). The type and periods of allo-HSCT inﬂuenced the timing and structure of critical illnesses. The ICU mortality rate after all ICU admissions and readmissions was 59.8 % with a maximum follow-up of 9 years. The risk factors of ICU mortality were the occurrence of critical conditions after +30 days of allo-HSCT, the need for mechanical ventilation and vasopressors. The overall survival (OS) rate of ICU admitted allo-HSCs recipients was 13.8 %. Sepsis and/or SS that occurred in the early phase after allo-HSCT were characterized by the most favorable long-term outcome (OS — 43.8 %) among all complications of the peritransplantation period. The OS of patients discharged from the ICU was worse than OS of patients who did not require ICU admission (34.6 % vs. 58.3 %; p = 0.0013). Conclusion. Transplant centers should have a specialized ICU because more than a quarter of allo-HSCT recipients experience life-threatening complications at different allo-HSCT periods. Sepsis and SS occurring in the early pre-engraftment phase had a more favorable prognosis than other life-threatening complications. The long-term outcomes in allo-HSCs recipients who survived critical illness are worse than in recipients who did not require ICU admission.

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Role of the intensive care in treatment of patients with acute myeloid leukemia

Cited by 2 publications

References 50 publications

Role of the intensive care in allogeneic hematopoietic stem cell transplantation

Role of the intensive care in allogeneic hematopoietic stem cell transplantation

Intensive care of life-threatening complications in allogeneic hematopoietic stem cell recipients

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