Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2008;12(3):R77.
doi: 10.1186/cc6923. Epub 2008 Jun 11.

Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis

Damon C Scales  1 , Deva Thiruchelvam, Alexander Kiss, William J Sibbald, Donald A Redelmeier
Affiliations

Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis

Damon C Scales et al. Crit Care. 2008.

Abstract

Introduction: Intensive care unit (ICU) admission for bone marrow transplant recipients immediately following transplantation is an ominous event, yet the survival of these patients with subsequent ICU admissions is unknown. Our objective was to determine the long-term outcome of bone marrow transplant recipients admitted to an ICU during subsequent hospitalizations.

Methods: We conducted a population-based cohort analysis of all adult bone marrow transplant recipients who received subsequent ICU care in Ontario, Canada from 1 January 1992 to 31 March 2002. The primary endpoint was mortality at 1 year.

Results: A total of 2,653 patients received bone marrow transplantation; 504 of which received ICU care during a subsequent hospitalization. Patients receiving any major procedure during their ICU stay had higher 1-year mortality than those patients who received no ICU procedure (87% versus 44%, P < 0.0001). Death rates at 1 year were highest for those receiving mechanical ventilation (87%), pulmonary artery catheterization (91%), or hemodialysis (94%). In combination, the strongest independent predictors of death at 1 year were mechanical ventilation (odds ratio, 7.4; 95% confidence interval, 4.8 to 11.4) and hemodialysis (odds ratio, 8.7; 95% confidence interval, 2.1 to 36.7), yet no combination of procedures uniformly predicted 100% mortality.

Conclusion: The prognosis of bone marrow transplant recipients receiving ICU care during subsequent hospitalizations is very poor but should not be considered futile.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Time from bone marrow transplant to intensive care unit admission. Kaplan–Meier curves showing outcomes following bone marrow transplant (BMT) hospitalization. y axis, percentage of original cohort remaining event-free following discharge from BMT (n = 2,653); x axis, time in years from BMT discharge. Curves represent patients still alive following BMT hospitalization (no deaths, lower curves) and patients remaining free of the intensive care unit (ICU) following BMT hospitalization (censoring both deaths and patients lost to follow up) (no subsequent ICU, upper curves). Black lines, survival following autologous BMT; gray lines, survival following allogeneic BMT.
Figure 2
Figure 2
Survival of bone marrow transplant recipients following intensive care unit admission. Kaplan–Meier curve showing survival. y axis, percentage of patients who required subsequent intensive care unit (ICU) admission following discharge from bone marrow transplant (BMT) (n = 504); x axis, time in years from ICU admission during subsequent hospitalization. Black lines, survival following autologous BMT; gray lines, survival following allogeneic BMT.
See this image and copyright information in PMC

References

    1. Clift RA, Buckner CD, Appelbaum FR, Bearman SI, Petersen FB, Fisher LD, Anasetti C, Beatty P, Bensinger WI, Doney K. Allogeneic marrow transplantation in patients with acute myeloid leukemia in first remission: a randomized trial of two irradiation regimens. Blood. 1990;76:1867–1871. - PubMed
    1. Kernan NA, Bartsch G, Ash RC, Beatty PG, Champlin R, Filipovich A, Gajewski J, Hansen JA, Henslee-Downey J, McCullough J. Analysis of 462 transplantations from unrelated donors facilitated by the National Marrow Donor Program. N Engl J Med. 1993;328:593–602. doi: 10.1056/NEJM199303043280901. - DOI - PubMed
    1. Aversa F, Tabilio A, Velardi A, Cunningham I, Terenzi A, Falzetti F, Ruggeri L, Barbabietola G, Aristei C, Latini P, Reisner Y, Martelli MF. Treatment of high-risk acute leukemia with T-cell-depleted stem cells from related donors with one fully mismatched HLA haplotype. N Engl J Med. 1998;339:1186–1193. doi: 10.1056/NEJM199810223391702. - DOI - PubMed
    1. Horak DA, Forman SJ. Critical care of the hematopoietic stem cell patient [review, 122 refs] Crit Care Clin. 2001;17:671–695. doi: 10.1016/S0749-0704(05)70203-7. - DOI - PubMed
    1. Kotloff RM, Ahya VN, Crawford SW. Pulmonary complications of solid organ and hematopoietic stem cell transplantation. Am J Respir Crit Care Med. 2004;170:22–48. doi: 10.1164/rccm.200309-1322SO. - DOI - PubMed