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. 2022 Feb;101(2):389-395.
doi: 10.1007/s00277-021-04698-3. Epub 2021 Oct 20.

Allogeneic stem cell transplant recipients admitted to the intensive care unit during the peri-transplant period have unfavorable outcomes-results of a retrospective analysis from a German university hospital

Jorge Garcia Borrega #  1 , Jan-Michel Heger #  1 , Philipp Koehler  1   2 , Udo Holtick  1 , Michael Hallek  1 , Christof Scheid  1 , Boris Böll  1 , Alexander Shimabukuro-Vornhagen  1 , Matthias Kochanek #  1 , Dennis A Eichenauer #  3   4
Affiliations

Allogeneic stem cell transplant recipients admitted to the intensive care unit during the peri-transplant period have unfavorable outcomes-results of a retrospective analysis from a German university hospital

Jorge Garcia Borrega et al. Ann Hematol. 2022 Feb.

Abstract

The prognosis of allogeneic stem cell transplant recipients admitted to the intensive care unit (ICU) has improved over the last decades. However, data focusing on patients treated in the ICU during the peri-transplant period are scarce. We therefore conducted an analysis comprising 70 patients who had allogeneic stem cell transplantation at the University Hospital Cologne between 2014 and 2020 and were admitted to the ICU between the initiation of conditioning therapy and day 30 after transplantation. The median age was 59 years (range: 18 - 72 years). 50% of patients were female. Sepsis was the most common cause for ICU admission (49%). Mechanical ventilation (MV) was required in 56% of patients, 27% had renal replacement therapy (RRT), and 64% needed vasopressors. The ICU, hospital, 90-day, and 1-year survival rates were 48.6%, 38.6%, 35.7%, and 16.2%, respectively. MV and/or RRT during the ICU stay were associated with an impaired survival (p < 0.0001). The same was true for the use of vasopressors (p < 0.0001). In contrast, baseline characteristics did not impact the outcome. Cardiopulmonary resuscitation (CPR) was performed in 17% of patients. None of the patients undergoing CPR was alive at 1 year. Among patients who died after discharge from the ICU (n = 23), sepsis and other infectious complications represented the major causes of death (48%). Taken together, the present analysis indicates unfavorable outcomes for allogeneic stem cell transplant recipients admitted to the ICU during the peri-transplant period. The data may help to make informed decisions with patients and their families.

Keywords: Allogeneic stem cell transplantation; Intensive care unit; Mechanical ventilation; Prognosis; Renal replacement therapy.

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Conflict of interest statement

PK is supported by the German Federal Ministry of Research and Education and the State of North Rhine-Westphalia, Germany, and has received non-financial scientific grants from Miltenyi Biotec GmbH, Bergisch-Gladbach, Germany, and the Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany, and received lecture honoraria from and/or is an advisor to Akademie für Infektionsmedizin e.V., Ambu GmbH, Astellas Pharma, European Confederation of Medical Mycology, Gilead Sciences, GPR Academy Rüsselsheim, MSD Sharp & Dohme GmbH, Noxxon N.V., and University Hospital, LMU Munich, outside the submitted work; the other authors declare no potential conflicts of interest.

Figures

Fig. 1
Fig. 1
A Overall survival according to age (< 40 years vs 40–60 years vs > 60 years). B Overall survival according to HCT-CI (0–2 vs > 2). C Overall survival according to remission status prior to aSCT (CR vs PR vs SD/MRD positive vs PD). D Overall survival according to the presence of acute GvHD. Legend: HCT-CI, Hematopoietic Cell Transplantation-specific Comorbidity Index; aSCT, allogeneic stem cell transplantation; CR, complete remission; PR, partial remission; SD, stable disease; MRD, measurable residual disease; PD, progressive disease; GvHD, graft-versus-host disease
Fig. 2
Fig. 2
A Overall survival according to the necessity of MV. B Overall survival according to the necessity of RRT. C Overall survival according to the necessity of MV and/or RRT (MV and/or RRT vs no MV and/or RRT). D Overall survival according to the necessity to use vasopressors. Legend: MV, mechanical ventilation; RRT, renal replacement therapy
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