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Solaiman OM, Elhassan T, Fakih RE, Mannan A, Alduhailib Z, Mahdali AA, Alzahrani H, Jamil M, Chaudhri N, Elhazmi A, Kolko M, Al-Sharif FZ, Alrbiaan A, Shaban M, Shaheen M, Salahuddin N, Alfraih FA, Altarifi AS, Hassanein M, Hosaini S, Alhashim N, Mohamed AA, Hanbali A, Aljanoubi AH, Al-Obaidi NR, Rasheed W, Maghrabi K, Almohareb F, Soubani A, Aljurf M, Ahmed SO. Outcomes and Long-Term Survival of Adolescent and Young Adult Patients Admitted to the Intensive Care Unit Following Allogeneic Hematopoietic Stem Cell Transplantation: A Single-Center Experience of 152 Patients. Hematol Oncol Stem Cell Ther 2024; 17:110-119. [PMID: 38560973 DOI: 10.56875/2589-0646.1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/13/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Prognostic factors reliably predicting outcomes for critically ill adolescent and young adult (AYA) patients undergoing allogeneic hematopoietic cell transplantation (allo-HSCT) are lacking. We assessed transplant and intensive care unit (ICU)-related factors impacting patient outcomes. PATIENTS AND METHODS AYA patients who underwent allo-HSCT and required ICU admission at a Tertiary care Centre, during the period of 2003-2013, were included in this retrospective review. This was a non-interventional study. Only outcomes after the first allo-HSCT and index ICU admissions were analyzed. Disease-, transplant-, and ICU-related variables were analyzed to identify risk factors predictive of survival. RESULTS Overall, 152 patients were included (males, 60.5%); median age at transplantation was 24 years (interquartile range [IQR] 18-32.5); median age at admission to the ICU was 25.8 years (IQR 19-34). Eighty-four percent underwent transplantation for a hematological malignancy; 129 (85%) received myeloablative conditioning. Seventy-one percent of ICU admissions occurred within the first year after allo-HSCT. ICU admission was primarily due to respiratory failure (47.3%) and sepsis (43.4%). One hundred and three patients (68%) died within 28 days of ICU admission. The 1- and 5-year overall survival rates were 19% and 17%, respectively. Main causes for ICU-related death were refractory septic shock with multiorgan failure (n = 49, 32%) and acute respiratory distress syndrome (ARDS) (n = 39, 26%). Univariate analysis showed that ICU mortality was associated with an Acute Physiology and Chronic Health Evaluation (APACHE) II score >20, a sequential organ failure assessment (SOFA score) > 12, a high lactate level, anemia, thrombocytopenia, leukopenia, hyperbilirubinemia, a high international normalized ratio (INR) and acute graft-versus-host disease (GVHD). Multivariate analysis identified thrombocytopenia, high INR, and acute GVHD as independent predictors of mortality. CONCLUSIONS In AYA allo-HSCT patients admitted to the ICU, mortality remains high. Higher SOFA and APACHE scores, the need for organ support, thrombocytopenia, coagulopathy, and acute GVHD predict poor outcomes.
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Affiliation(s)
- Othman M Solaiman
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Tusneem Elhassan
- Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Riad E Fakih
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Hematology, Stem Cell Transplantation and Cellular Therapy, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdul Mannan
- Betsi Cadwaladr University, 32 Hospital, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd, Wales, UK
| | - Zainab Alduhailib
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ashwaq A Mahdali
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hazzaa Alzahrani
- Hematology, Stem Cell Transplantation and Cellular Therapy, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mouhamad Jamil
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Naeem Chaudhri
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Hematology, Stem Cell Transplantation and Cellular Therapy, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Alyaa Elhazmi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Interhealth Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Kolko
- Intensive Care Unit, Security Forces Hospital Program, Makkah, Saudi Arabia
| | - Fahad Z Al-Sharif
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Hematology, Stem Cell Transplantation and Cellular Therapy, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdullah Alrbiaan
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Shaban
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Marwan Shaheen
- Hematology, Stem Cell Transplantation and Cellular Therapy, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Nawal Salahuddin
- Department of Pulmonary and Critical Care Medicine, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Feras A Alfraih
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Hematology, Stem Cell Transplantation and Cellular Therapy, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ashraf S Altarifi
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | - Sulaiman Hosaini
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Noura Alhashim
- Hematology, Stem Cell Transplantation and Cellular Therapy, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Alaa A Mohamed
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Amr Hanbali
- Hematology, Stem Cell Transplantation and Cellular Therapy, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ali H Aljanoubi
- Critical Care Services Administration, Adult Critical Care Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Walid Rasheed
- Hematology, Stem Cell Transplantation and Cellular Therapy, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khalid Maghrabi
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fahad Almohareb
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Hematology, Stem Cell Transplantation and Cellular Therapy, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ayman Soubani
- Harper University Hospital, Wayne State University School of Medicine, USA
| | - Mahmoud Aljurf
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Hematology, Stem Cell Transplantation and Cellular Therapy, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Syed O Ahmed
- Hematology, Stem Cell Transplantation and Cellular Therapy, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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