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Lueck C, Tzalavras A, Wohlfarth P, Meedt E, Kiehl M, Turki AT, Hoeper MM, Eder M, Cserna J, Buchtele N, Wolff D, Schellongowski P, Beutel G, Liebregts T. Impact of chronic graft-versus-host-disease on intensive care outcome in allogeneic hematopoietic stem cell recipients. Bone Marrow Transplant 2023; 58:303-310. [PMID: 36496524 PMCID: PMC10005928 DOI: 10.1038/s41409-022-01875-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 12/14/2022]
Abstract
Chronic graft-vs-host-disease (cGvHD) is the most relevant long-term complication after allogeneic stem cell transplantation (HSCT) with major impact on non-relapse mortality, but data on intensive care unit (ICU) outcome are missing. In this retrospective, multicenter study we analyzed 174 adult HSCT recipients with cGvHD requiring intensive care treatment. Skin, pulmonary, liver, and intestinal involvement were present in 76.7%, 47.1%, 38.1% and 24.1%, respectively, and a total of 63.2% had severe cGvHD. Main reasons for ICU admission were respiratory failure (69.7%) and sepsis (34.3%). Hospital- and 3-year OS rates were 51.7% and 28.6%, respectively. Global severity of cGvHD did not impact short- and long-term survival. However, patients with severe liver cGvHD or the overlap subtype had a reduced hospital survival, while severe pulmonary cGvHD was associated with worse long-term survival. In multivariate analysis need for invasive ventilation (HR 1.08 (95% CI 1.02-1.14)) or hemodialysis (HR 1.73 (95% CI 1.14-2.62)) and <1 year since HSCT (HR 1.56 (95% CI 1.03-2.39)) were independently associated with a poorer survival. While the global severity of cGvHD does not per se affect patients' survival after intensive care treatment, pre-existing severe hepatic, intestinal or pulmonary cGvHD is associated with worse outcomes.
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Affiliation(s)
- Catherina Lueck
- Department for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.,iCHOP - Intensive Care in Hematologic and Oncologic Patients, Essen, Germany
| | - Asterios Tzalavras
- iCHOP - Intensive Care in Hematologic and Oncologic Patients, Essen, Germany.,Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Philipp Wohlfarth
- iCHOP - Intensive Care in Hematologic and Oncologic Patients, Essen, Germany.,Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Meedt
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Michael Kiehl
- iCHOP - Intensive Care in Hematologic and Oncologic Patients, Essen, Germany.,Department of Internal Medicine I, Clinic Frankfurt/Oder GmbH, Frankfurt/Oder, Germany
| | - Amin T Turki
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Marius M Hoeper
- Department for Respiratory Diseases and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Matthias Eder
- Department for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Julia Cserna
- iCHOP - Intensive Care in Hematologic and Oncologic Patients, Essen, Germany.,Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Nina Buchtele
- iCHOP - Intensive Care in Hematologic and Oncologic Patients, Essen, Germany.,Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Daniel Wolff
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Peter Schellongowski
- iCHOP - Intensive Care in Hematologic and Oncologic Patients, Essen, Germany.,Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Gernot Beutel
- Department for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.,iCHOP - Intensive Care in Hematologic and Oncologic Patients, Essen, Germany
| | - Tobias Liebregts
- iCHOP - Intensive Care in Hematologic and Oncologic Patients, Essen, Germany. .,Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.
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2
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Marumo A, Omori I, Tara S, Otsuka Y, Konuma R, Adachi H, Wada A, Kishida Y, Konishi T, Nagata A, Yamada Y, Nagata R, Noguchi Y, Toya T, Igarashi A, Najima Y, Kobayashi T, Yamaguchi H, Inokuchi K, Sakamaki H, Ohashi K, Doki N. Cyclophosphamide-induced cardiotoxicity at conditioning for allogeneic hematopoietic stem cell transplantation would occur among the patients treated with 120 mg/kg or less. Asia Pac J Clin Oncol 2022; 18:e507-e514. [PMID: 35289086 DOI: 10.1111/ajco.13674] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/24/2021] [Indexed: 11/28/2022]
Abstract
Cyclophosphamide (CY)-induced cardiotoxicity involves rare lethal complications. We previously reported the cardiac events of 811 allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients; 12 out of 811 recipients (1.5%) developed fatal heart failure. The mortality rate was also very high (91.6%, 11/12). CY dose (200 mg/kg or more) was reported as the independent risk factor. The main disease in patients treated with 200 mg/kg or more of CY was severe aplastic anemia (AA). Therefore, we reduced the dose of CY during conditioning for AA (from 200 to 100 mg/kg), and then we analyzed the clinical features of 294 patients who received a total dose of at least 100 mg/kg of CY. We also compared the clinical features between the current study and our previous study. The proportion of patients treated with at least 200 mg/kg of CY was reduced from 4.2% to 0%. However, CY-induced heart failure occurred in four of the 294 patients (1.4%), which was similar to the finding reported in our previous study (1.5%). Two of these four patients received a post-transplant CY (PTCy) regimen (CY 100 mg/kg). All four patients were treated in the cardiac intensive care unit (C-ICU), and two patients survived. In summary, even the CY dose of 120 mg/kg or less would cause cardiotoxicity. We should also carefully monitor patients treated with PTCy, considering the possibility of CY-induced cardiotoxicity. Early diagnosis and ICU management have contributed to improved outcomes.
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Affiliation(s)
- Atsushi Marumo
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.,Department of Hematology, Nippon Medical School, Tokyo, Japan
| | - Ikuko Omori
- Department of Hematology, Nippon Medical School, Tokyo, Japan
| | - Shuhei Tara
- Division of Cardiovascular Intensive Care Unit, Nippon Medical School, Tokyo, Japan
| | - Yuki Otsuka
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Ryosuke Konuma
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Hiroto Adachi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Atsushi Wada
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yuya Kishida
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Tatsuya Konishi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Akihito Nagata
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yuta Yamada
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Ryohei Nagata
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yuma Noguchi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Takashi Toya
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Aiko Igarashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yuho Najima
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Takeshi Kobayashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | | | - Koiti Inokuchi
- Department of Hematology, Nippon Medical School, Tokyo, Japan
| | - Hisashi Sakamaki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Kazuteru Ohashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
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3
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Archanjo LVF, Caruso P, Nassar AP. One-year mortality of hematopoietic stem cell recipients admitted to an intensive care unit in a dedicated Brazilian cancer center: a retrospective cohort study. SAO PAULO MED J 2022; 141:107-113. [PMID: 35920534 PMCID: PMC10005466 DOI: 10.1590/1516-3180.2021.0986.r1.11052022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/11/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) recipients requiring intensive care unit (ICU) admission early after transplantation have a poor prognosis. However, many studies have only focused on allogeneic HSCT recipients. OBJECTIVES To describe the characteristics of HSCT recipients admitted to the ICU shortly after transplantation and assess differences in 1-year mortality between autologous and allogeneic HSCT recipients. DESIGN AND SETTING A single-center retrospective cohort study in a cancer center in Brazil. METHODS We included all consecutive patients who underwent HSCT less than a year before ICU admission between 2009 and 2018. We collected clinical and demographic data and assessed the 1-year mortality of all patients. The effect of allogeneic HSCT compared with autologous HSCT on 1-year mortality risk was evaluated in an unadjusted model and an adjusted Cox proportional hazard model for age and Sequential Organ Failure Assessment (SOFA) at admission. RESULTS Of the 942 patients who underwent HSCT during the study period, 83 (8.8%) were included in the study (autologous HSCT = 57 [68.7%], allogeneic HSCT = 26 [31.3%]). At 1 year after ICU admission, 21 (36.8%) and 18 (69.2%) patients who underwent autologous and allogeneic HSCT, respectively, had died. Allogeneic HSCT was associated with increased 1-year mortality (unadjusted hazard ratio, HR = 2.79 [confidence interval, CI, 95%, 1.48-5.26]; adjusted HR = 2.62 [CI 95%, 1.29-5.31]). CONCLUSION Allogeneic HSCT recipients admitted to the ICU had higher short- and long-term mortality rates than autologous HSCT recipients, even after adjusting for age and severity at ICU admission.
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Affiliation(s)
| | - Pedro Caruso
- MD, PhD. Physician and ICU coordinator, Professor. A.C. Camargo
Cancer Center, São Paulo (SP), Brazil. Professor, Discipline of Pulmonology,
Universidade de São Paulo (USP), São Paulo (SP), Brazil
| | - Antonio Paulo Nassar
- MD, PhD. Attending Physician and Professor, Intensive Care Unit,
A.C. Camargo Cancer Center, São Paulo (SP) Brazil
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Pretransplantation EASIX predicts intensive care unit admission in allogeneic hematopoietic cell transplantation. Blood Adv 2021; 5:3418-3426. [PMID: 34495311 DOI: 10.1182/bloodadvances.2021004812] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/13/2021] [Indexed: 12/26/2022] Open
Abstract
The Endothelial Activation and Stress Index (EASIX) is a laboratory-based prognosis index defined as creatinine × lactate dehydrogenase/platelets. When measured at pretransplantation evaluation (EASIX-PRE), it predicts allogeneic hematopoietic cell transplantation (alloHCT) mortality. This study explores its ability to predict intensive care unit (ICU) admission and validates EASIX-PRE predictive power for overall survival (OS) and nonrelapse mortality (NRM) in 167 consecutive patients undergoing alloHCT. EASIX-PRE was calculated retrospectively in all patients and transformed into log2 values (log2-EASIX-PRE). Log2-EASIX-PRE predicted ICU admission (hazard ratio [HR], 1.41; P < .001), OS (HR, 1.19; P = .011), and NRM (HR, 1.28; P = .004). The most discriminating EASIX-PRE cutoff value for risk of ICU admission was the 75th percentile (2.795); for OS and NRM, it was the median value (1.703). Patients with EASIX-PRE >2.795 had higher incidence of ICU admission in comparison with patients with lower EASIX-PRE values (day +180, 35.8% vs 12.8%; HR, 2.28; P = .010). Additionally, patients with EASIX-PRE >1.073 had lower OS (2 years, 57.7% vs 68.7%; HR, 1.98; P = .006) and higher NRM (2 years, 38.7% vs 18.5%; HR, 2.92; P = .001) than patients with lower EASIX-PRE results. Log2-EASIX-PRE was not associated with incidence of transplantation-associated microangiopathy, sinusoidal obstruction syndrome, or acute graft-versus-host disease. This study proposes EASIX-PRE as a prognostic tool to identify patients undergoing alloHCT at increased risk of severe organ dysfunction and who would therefore require ICU admission. Early identification of patients at high risk of severe events could contribute to personalized intervention design. Additionally, it validates the association between EASIX-PRE and OS and NRM in those undergoing alloHCT.
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5
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Gournay V, Dumas G, Lavillegrand JR, Hariri G, Urbina T, Baudel JL, Ait-Oufella H, Maury E, Brissot E, Legrand O, Malard F, Mohty M, Guidet B, Duléry R, Bigé N. Outcome of allogeneic hematopoietic stem cell transplant recipients admitted to the intensive care unit with a focus on haploidentical graft and sequential conditioning regimen: results of a retrospective study. Ann Hematol 2021; 100:2787-2797. [PMID: 34476574 DOI: 10.1007/s00277-021-04640-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022]
Abstract
Haploidentical transplantation has extended the availability of allogeneic hematopoietic stem cell transplant (alloHCT) to almost all patients. Sequential conditioning regimens have been proposed for the treatment of hematological active disease. Whether these new transplantation procedures affect the prognosis of critically ill alloHCT recipients remains unknown. We evaluated this question in a retrospective study including consecutive alloHCT patients admitted to the intensive care unit of a tertiary academic center from 2010 to 2017. During the study period, 412 alloHCTs were performed and 110 (27%) patients-median age 55 (36-64) years-were admitted to ICU in a median time of 58.5 (14-245) days after alloHCT. Twenty-nine (26%) patients had received a haploidentical graft and 34 (31%) a sequential conditioning. Median SOFA score was 9 (6-11). Invasive mechanical ventilation (MV) was required in 61 (55%) patients. Fifty-six (51%) patients died in the hospital. Independent factors associated with in-hospital mortality were as follows: MV (OR=8.44 [95% CI 3.30-23.19], p<0.001), delta SOFA between day 3 and day 1 (OR=1.60 [95% CI 1.31-2.05], p<0.0001), and sequential conditioning (OR=3.7 [95% CI 1.14-12.92], p=0.033). Sequential conditioning was also independently associated with decreased overall survival (HR=1.86 [95% CI 1.05-3.31], p=0.03). Other independent factors associated with reduced overall survival were HCT-specific comorbidity index ≥2 (HR=1.76 [95% CI 1.10-2.84], p=0.02), acute GVHD grade ≥2 (HR=1.88 [95% CI 1.14-3.10], p=0.01), MV (HR=2.37 [95% CI 1.38-4.07, p=0.002), and vasopressors (HR=2.21 [95% CI 1.38-3.54], p=0.001). Haploidentical transplantation did not affect outcome. Larger multicenter studies are warranted to confirm these results.
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Affiliation(s)
- Viviane Gournay
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France
| | - Guillaume Dumas
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France
| | - Jean-Rémi Lavillegrand
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France
| | - Geoffroy Hariri
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France
| | - Tomas Urbina
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France
| | - Jean-Luc Baudel
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Inserm U970, Paris Research Cardiovascular Center, Paris, France
| | - Eric Maury
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France
| | - Eolia Brissot
- Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,UMRS 938, Inserm, Paris, France
| | - Ollivier Legrand
- Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,UMRS 938, Inserm, Paris, France
| | - Florent Malard
- Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,UMRS 938, Inserm, Paris, France
| | - Mohamad Mohty
- Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,UMRS 938, Inserm, Paris, France
| | - Bertrand Guidet
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.,Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Inserm U1136, Paris, France
| | - Rémy Duléry
- Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France.,Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,UMRS 938, Inserm, Paris, France
| | - Naïke Bigé
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France.
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6
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Díaz-Lagares C, Fox L, García-Roche A, Santafe M, Romera I, Barba P, Pacheco A, Roldán E, Plata-Menchaca E, Roca O, Pérez M, Valcarcel D, Ferrer R. Sequential Organ Failure Assessment Score and the Need for Organ Support Predict Mortality in Allogeneic Stem Cell Transplant Patients Admitted to the Intensive Care Unit. Transplant Cell Ther 2021; 27:865.e1-865.e7. [PMID: 34217846 DOI: 10.1016/j.jtct.2021.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/12/2021] [Accepted: 06/23/2021] [Indexed: 10/21/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective therapy resulting in increased definitive cure rates or extended disease-free survival in various malignant and nonmalignant hematologic diseases. However, because of the high risk of severe complications of this therapy, up to 50% of patients may require being admitted to the intensive care unit (ICU) to manage life-threatening conditions. We aimed to evaluate the in-hospital mortality of allo-HSCT recipients admitted to the ICU and to identify those variables associated with in-hospital mortality. A 10-year (January 2010 to December 2019), single-center, retrospective study was conducted in Vall d´Hebron University Hospital, Barcelona. We included all consecutive allo-HSCT patients who required admission to the ICU. Baseline and disease-related characteristics were registered. Severity scores and the need for organ support were also assessed on days 1, 3, and 5 of ICU admission. In-hospital mortality-associated independent variables were identified using the Cox proportional hazards regression model. Three hundred twenty-three patients underwent allo-HSCT during the study period, of whom 82 (25%) were admitted to the ICU; 53 (65%) male, with a median age of 51 (38-59) years. Most patients received allo-HSCT for the treatment of lymphoma (20 patients [24%]) or acute leukemia (44 patients [54%]). The median Acute Physiology And Chronic Health Evaluation II score was 23 (17-28), and the median Sequential Organ Failure Assessment (SOFA) score on admission was 9 (7-11). Forty-nine (60%) patients died in the ICU, and 11 (13%) died in the hospital after being discharged from the ICU. Disease-related characteristics were not associated with mortality. Yet, SOFA score on day 1 (hazard ratio [HR]: 1.11 [95% confidence interval {CI}: 1.04-1.02]; P = .002), the need for vasopressors on day 3 (HR: 2.35 [95% CI: 1.27-4.36]; P = .007), and a nondecreasing SOFA score on day 5 (HR: 2.13 [95% CI: 1.03-4.39]; P = .04), were independently associated with in-hospital mortality. Mortality in allo-HSCT patients who require ICU admission remains high. In the present study, SOFA score, the need for vasopressors on day 3, and a nondecreasing SOFA score on day 5 predicted in-hospital mortality.
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Affiliation(s)
- Cándido Díaz-Lagares
- Intensive Care Department, Vall d´Hebron Hospital Universitari, Barcelona, Spain; SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain.
| | - Laura Fox
- Hematology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d´Hebron Hospital Universitari, Barcelona, Spain
| | - Alejandra García-Roche
- Intensive Care Department, Vall d´Hebron Hospital Universitari, Barcelona, Spain; SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Manel Santafe
- Intensive Care Department, Vall d´Hebron Hospital Universitari, Barcelona, Spain; SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Irene Romera
- Intensive Care Department, Vall d´Hebron Hospital Universitari, Barcelona, Spain; SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Pere Barba
- Hematology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d´Hebron Hospital Universitari, Barcelona, Spain
| | - Andrés Pacheco
- Intensive Care Department, Vall d´Hebron Hospital Universitari, Barcelona, Spain; SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Elisa Roldán
- Hematology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d´Hebron Hospital Universitari, Barcelona, Spain
| | - Erika Plata-Menchaca
- SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Oriol Roca
- Intensive Care Department, Vall d´Hebron Hospital Universitari, Barcelona, Spain; SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Marcos Pérez
- Intensive Care Department, Vall d´Hebron Hospital Universitari, Barcelona, Spain; SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - David Valcarcel
- Hematology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d´Hebron Hospital Universitari, Barcelona, Spain
| | - Ricard Ferrer
- Intensive Care Department, Vall d´Hebron Hospital Universitari, Barcelona, Spain; SODIR Research Group, Vall d´Hebron Institut de Recerca (VHIR), Barcelona, Spain
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