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.

Fig. 1

(A) Kaplan–Meier survival curve for all patients admitted to the intensive care unit (ICU) (including deaths on ICU), n = 164. (B) Kaplan–Meier survival curve for all patients: Overall Survival after last admission by transplant conditioning intensity (Survival curves compared using log-rank test). (C) Kaplan–Meier survival curve for ICU survivors: Overall Survival after last discharge from ICU, n = 53. (D) Kaplan–Meier survival curve for ICU survivors: Overall Survival by conditioning (Survival curves compared using log-rank test). (E) Kaplan–Meier survival curve for ICU survivors: Overall Survival by ventilatory support on ICU (Survival curves compared using log-rank test).