Allogeneic hematopoietic stem cell transplantation after reduced intensity conditioning regimen: Outcomes of patients admitted to intensive care unit

Abstract

Purpose: The prognosis of allogeneic hematopoietic stem cell transplantation (HSCT) patients admitted to the intensive care unit (ICU) is still poor. Overall, when these patients receive reduced intensity conditioning (RIC) regimens, the survival is better. To date, no study has specifically evaluated the outcome of RIC allogeneic HSCT admitted to the ICU.

Methods: We realized a retrospective study of 102 patients admitted to the ICU among a cohort of 601 consecutive patients receiving RIC regimens. The primary objective of the study was to assess in-ICU and inhospital mortality rates.

Results: The ICU mortality was 39.2%, and the hospital mortality was 59.8%. The median overall survival of ICU patients was 8.2 months (95% confidence interval [CI], 5.7-10.6) vs 75 (95% CI, 63-87) in non-ICU patients (P < .0001). During hospital stay, an ICU admission for neurologic dysfunction was independently associated with hospital survival (P = .012). The use of invasive mechanical ventilation (IMV; P = .011), Simplified Acute Physiology Score II (P = .003), and longer time between diagnosis of malignancy and HSCT (P = .012) were associated with hospital mortality. The overall survival of the ICU survivors was significantly lower than that of non-ICU patients (hazard ratio, 3.61 [95% CI, 2.18-4.59]; P < .001). The median survival of ICU survivors was 9 months (95% CI, 4-14) vs 75 (95% CI, 63-87) in non-ICU patients (P < .0001). Noninvasive ventilation (NIV) was successful (not followed by IMV in 61% of cases [25/41 NIV patients]), and failure of NIV was not associated with hospital mortality in patients treated with subsequent IMV.

Conclusion: From our study, short-term survival rates of ICU patients receiving RIC regimens justify a broad ICU admission policy. The use of IMV is associated with hospital mortality, whereas the use of NIV is frequently successful. Long-term outcome remains poor after ICU discharge.

Keywords: Allogeneic hematopoietic stem cell transplantation; Hematology patients; Intensive care unit; Mechanical ventilation; Prognosis; Reduced-intensity conditioning regimen.