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van Mourik N, Oomen JJ, van Vught LA, Biemond BJ, van den Bergh WM, Blijlevens NMA, Vlaar APJ, Müller MCA. The predictive value of the modified early warning score for admission to the intensive care unit in patients with a hematologic malignancy - A multicenter observational study. Intensive Crit Care Nurs 2023; 79:103486. [PMID: 37441816 DOI: 10.1016/j.iccn.2023.103486] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/26/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES The modified early warning score (MEWS) is used to detect clinical deterioration of hospitalized patients. We aimed to investigate the predictive value of MEWS and derived quick Sequential Organ Failure Assessment (qSOFA) scores for intensive care unit admission in patients with a hematologic malignancy admitted to the ward. DESIGN Retrospective, observational study in two Dutch university hospitals. SETTING Data from adult patients with a hematologic malignancy, admitted to the ward over a 2-year period, were extracted from electronic patient files. MAIN OUTCOME MEASURES Intensive care admission. RESULTS We included 395 patients with 736 hospital admissions; 2% (n = 15) of admissions resulted in admission to the intensive care unit. A higher MEWS (OR 1.5; 95 %CI 1.3-1.80) and qSOFA (OR 4.4; 95 %CI 2.1-9.3) were associated with admission. Using restricted cubic splines, a rise in the probability of admission for a MEWS ≥ 6 was observed. The AUC of MEWS for predicting admission was 0.830, the AUC of qSOFA was 0.752. MEWS was indicative for intensive care unit admission two days before admission. CONCLUSIONS MEWS was a sensitive predictor of ICU admission in patients with a hematologic malignancy, superior to qSOFA. Future studies should confirm cut-off values and identify potential additional characteristics, to further enhance identification of critically ill hemato-oncology patients. IMPLICATIONS FOR CLINICAL PRACTICE The Modified Early Warning Score (MEWS) can be used as a tool for healthcare providers to monitor clinical deterioration and predict the need for intensive care unit admission in patients with a hematologic malignancy. Yet, consistent application and potential reevaluation of current thresholds is crucial. This will enable bedside nurses to more effectively identify patients needing adjunctive care, facilitating timely interventions and improved outcome.
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Affiliation(s)
- Niels van Mourik
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands.
| | - Jesse J Oomen
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lonneke A van Vught
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Bart J Biemond
- Department of Hematology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Walter M van den Bergh
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nicole M A Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Marcella C A Müller
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
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2
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Tigu AB, Constantinescu CS, Teodorescu P, Kegyes D, Munteanu R, Feder R, Peters M, Pralea I, Iuga C, Cenariu D, Marcu A, Tanase A, Colita A, Drula R, Bergthorsson JT, Greiff V, Dima D, Selicean C, Rus I, Zdrenghea M, Gulei D, Ghiaur G, Tomuleasa C. Design and preclinical testing of an anti-CD41 CAR T cell for the treatment of acute megakaryoblastic leukaemia. J Cell Mol Med 2023; 27:2864-2875. [PMID: 37667538 PMCID: PMC10538266 DOI: 10.1111/jcmm.17810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/28/2023] [Accepted: 05/26/2023] [Indexed: 09/06/2023] Open
Abstract
Acute megakaryoblastic leukaemia (AMkL) is a rare subtype of acute myeloid leukaemia (AML) representing 5% of all reported cases, and frequently diagnosed in children with Down syndrome. Patients diagnosed with AMkL have low overall survival and have poor outcome to treatment, thus novel therapies such as CAR T cell therapy could represent an alternative in treating AMkL. We investigated the effect of a new CAR T cell which targets CD41, a specific surface antigen for M7-AMkL, against an in vitro model for AMkL, DAMI Luc2 cell line. The performed flow cytometry evaluation highlighted a percentage of 93.8% CAR T cells eGFP-positive and a limited acute effect on lowering the target cell population. However, the interaction between effector and target (E:T) cells, at a low ratio, lowered the cell membrane integrity, and reduced the M7-AMkL cell population after 24 h of co-culture, while the cytotoxic effect was not significant in groups with higher E:T ratio. Our findings suggest that the anti-CD41 CAR T cells are efficient for a limited time spawn and the cytotoxic effect is visible in all experimental groups with low E:T ratio.
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Affiliation(s)
- Adrian Bogdan Tigu
- Medfuture Research Center for Advanced MedicineIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
| | - Catalin Sorin Constantinescu
- Medfuture Research Center for Advanced MedicineIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
- Department of HematologyIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
- Intensive Care UnitEmergency Clinical HospitalCluj‐NapocaRomania
| | - Patric Teodorescu
- Department of HematologyIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
- Department of Leukemia, Sidney Kimmel Cancer Center at Johns HopkinsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - David Kegyes
- Medfuture Research Center for Advanced MedicineIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
- Department of HematologyIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
| | - Raluca Munteanu
- Medfuture Research Center for Advanced MedicineIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
| | - Richard Feder
- Medfuture Research Center for Advanced MedicineIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
| | - Mareike Peters
- Medfuture Research Center for Advanced MedicineIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
- Department of HematologyIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
| | - Ioana Pralea
- Medfuture Research Center for Advanced MedicineIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
| | - Cristina Iuga
- Medfuture Research Center for Advanced MedicineIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
- Department of Drug AnalysisSchool of PharmacyIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
| | - Diana Cenariu
- Medfuture Research Center for Advanced MedicineIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
| | - Andra Marcu
- Department of PediatricsCarol Davila University of Medicine and PharmacyBucharestRomania
- Department of Stem Cell TransplantationFundeni Clinical InstituteBucharestRomania
| | - Alina Tanase
- Department of PediatricsCarol Davila University of Medicine and PharmacyBucharestRomania
- Department of Stem Cell TransplantationFundeni Clinical InstituteBucharestRomania
| | - Anca Colita
- Department of PediatricsCarol Davila University of Medicine and PharmacyBucharestRomania
- Department of Stem Cell TransplantationFundeni Clinical InstituteBucharestRomania
| | - Rares Drula
- Medfuture Research Center for Advanced MedicineIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
| | - Jon Thor Bergthorsson
- Stem Cell Research Unit, Biomedical Center, School of Health SciencesUniversity of IcelandReykjavíkIceland
- Department of Laboratory HematologyLandspitali University HospitalReykjavíkIceland
| | - Victor Greiff
- Department of ImmunologyUniversity of Oslo and Oslo University HospitalOsloNorway
| | - Delia Dima
- Department of HematologyIon Chiricuta Clinical Cancer CenterCluj NapocaRomania
| | - Cristina Selicean
- Department of HematologyIon Chiricuta Clinical Cancer CenterCluj NapocaRomania
| | - Ioana Rus
- Department of HematologyIon Chiricuta Clinical Cancer CenterCluj NapocaRomania
| | - Mihnea Zdrenghea
- Department of HematologyIon Chiricuta Clinical Cancer CenterCluj NapocaRomania
| | - Diana Gulei
- Medfuture Research Center for Advanced MedicineIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
| | - Gabriel Ghiaur
- Medfuture Research Center for Advanced MedicineIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
- Department of Leukemia, Sidney Kimmel Cancer Center at Johns HopkinsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Ciprian Tomuleasa
- Medfuture Research Center for Advanced MedicineIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
- Department of HematologyIuliu Hatieganu University of Medicine and PharmacyCluj‐NapocaRomania
- Department of HematologyIon Chiricuta Clinical Cancer CenterCluj NapocaRomania
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Constantinescu C, Moisoiu V, Tigu B, Kegyes D, Tomuleasa C. Outcomes of CAR-T Cell Therapy Recipients Admitted to the ICU: In Search for a Standard of Care-A Brief Overview and Meta-Analysis of Proportions. J Clin Med 2023; 12:6098. [PMID: 37763039 PMCID: PMC10531736 DOI: 10.3390/jcm12186098] [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: 08/20/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE Our primary objective was to describe the baseline characteristics, main reasons for intensive care unit (ICU) admission, and interventions required in the ICU across patients who received CAR-T cell immunotherapy. The secondary objectives were to evaluate different outcomes (ICU mortality) across patients admitted to the ICU after having received CAR-T cell therapy. MATERIALS AND METHODS We performed a medical literature review, which included MEDLINE, Embase, and Cochrane Library, of studies published from the inception of the databases until 2022. We conducted a systematic review with meta-analyses of proportions of several studies, including CAR-T cell-treated patients who required ICU admission. Outcomes in the meta-analysis were evaluated using the random-effects model. RESULTS We included four studies and analyzed several outcomes, including baseline characteristics and ICU-related findings. CAR-T cell recipients admitted to the ICU are predominantly males (62% CI-95% (57-66)). Of the total CAR-T cell recipients, 4% CI-95% (3-5) die in the hospital, and 6% CI-95% (4-9) of those admitted to the ICU subsequently die. One of the main reasons for ICU admission is acute kidney injury (AKI) in 15% CI-95% (10-19) of cases and acute respiratory failure in 10% CI-95% (6-13) of cases. Regarding the interventions initiated in the ICU, 18% CI-95% (13-22) of the CAR-T recipients required invasive mechanical ventilation during their ICU stay, 23% CI-95% (16-30) required infusion of vasoactive drugs, and 1% CI-95% (0.1-3) required renal replacement therapy (RRT). 18% CI-95% (13-22) of the initially discharged patients were readmitted to the ICU within 30 days, and the mean length of hospital stay is 22 days CI-95% (19-25). The results paint a current state of matter in CAR-T cell recipients admitted to the ICU. CONCLUSIONS To better understand immunotherapy-related complications from an ICU standpoint, acknowledge the deteriorating patient on the ward, reduce the ICU admission rate, advance ICU care, and improve the outcomes of these patients, a standard of care and research regarding CAR-T cell-based immunotherapies should be created. Studies that are looking from the perspective of intensive care are highly warranted because the available literature regarding this area is scarce.
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Affiliation(s)
- Catalin Constantinescu
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (C.C.); (C.T.)
- Department of Anesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
- Intensive Care Unit, Emergency Hospital, 400006 Cluj-Napoca, Romania
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
| | - Vlad Moisoiu
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Bogdan Tigu
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
| | - David Kegyes
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
| | - Ciprian Tomuleasa
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (C.C.); (C.T.)
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
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Cenariu D, Bumbea H, Colita A, Constantinescu C, Desmirean M, Iluta S, Lysák D, Mussetti A, Tichil I, Tanase A, Tomuleasa C. Progress in Hematopoietic Stem Cell Transplantation and Cellular Therapies. J Clin Med 2022; 11:jcm11247354. [PMID: 36555970 PMCID: PMC9784161 DOI: 10.3390/jcm11247354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Hematological malignancies are considered to be one of the most important causes of mortality and morbidity in the modern world [...].
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Affiliation(s)
- Diana Cenariu
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Horia Bumbea
- Department of Stem Cell Transplantation, University Emergency Hospital Bucharest, 022314 Bucharest, Romania
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, 022314 Bucharest, Romania
| | - Anca Colita
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, 022314 Bucharest, Romania
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Catalin Constantinescu
- Intensive Care Unit, Emergency Hospital, 400006 Cluj-Napoca, Romania
- Department of Anesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Minodora Desmirean
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Sabina Iluta
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400124 Cluj Napoca, Romania
| | - Daniel Lysák
- Department of Hematology and Oncology, University Hospital Pilsen, 32300 Pilsen, Czech Republic
- Faculty of Medicine in Pilsen, Charles University, 32300 Pilsen, Czech Republic
| | - Alberto Mussetti
- Clinical Hematology Department, Institut Català d’Oncologia-Hospitalet, 08901 Barcelona, Spain
- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), 08908 Barcelona, Spain
| | - Ioana Tichil
- Department of Anesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Alina Tanase
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, 022314 Bucharest, Romania
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Ciprian Tomuleasa
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400124 Cluj Napoca, Romania
- Correspondence:
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Prower E, Hadfield S, Saha R, Woo T, Ang KM, Metaxa V. A critical care outreach team under strain - Evaluation of the service provided to patients with haematological malignancy during the Covid-19 pandemic. J Crit Care 2022; 71:154109. [PMID: 35843047 PMCID: PMC9282870 DOI: 10.1016/j.jcrc.2022.154109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/18/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022]
Abstract
Purpose Critical Care Outreach Teams (CCOTs) have been associated with improved outcomes in patients with haematological malignancy (HM). This study aims to describe CCOT activation by patients with HM before and during the Covid-19 pandemic, assess amny association with worse outcomes, and examine the psychological impact on the CCOT. Materials and methods A retrospective, mixed-methods analysis was performed in HM patients reviewed by the CCOT over a two-year period, 01 July 2019 to 31 May 2021. Results The CCOT increased in size during the surge period and reviewed 238 HM patients, less than in the pre- and post-surge periods. ICU admission in the baseline, surge and the non-surge periods were 41.7%, 10.4% and 47.9% respectively. ICU mortality was 22.5%, 0% and 21.7% for the same times. Time to review was significantly decreased (p = 0.012). Semi-structured interviews revealed four themes of psychological distress: 1) time-critical work; 2) non-evidence based therapies; 3) feelings of guilt; 4) increased decision-making responsibility. Conclusions Despite the increase in total hospital referrals, the number of patients with HM that were reviewed during the surge periods decreased, as did their ICU admission rate and mortality. The quality of care provided was not impaired, as reflected by the number of patients receiving bedside reviews and the shorter-than-pre-pandemic response time.
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Affiliation(s)
- Emma Prower
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Sophie Hadfield
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Rohit Saha
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Timothy Woo
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Kar Mun Ang
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
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