Intensive Care Medicine

, Volume 32, Issue 1, pp 93–99 | Cite as

Outcome in severely ill patients with hematological malignancies who received intravenous chemotherapy in the intensive care unit

  • Dominique D. Benoit
  • Pieter O. Depuydt
  • Koenraad H. Vandewoude
  • Fritz C. Offner
  • Tom Boterberg
  • Carole A. De Cock
  • Lucien A. Noens
  • Ann M. Janssens
  • Johan M. Decruyenaere
Original

Abstract

Objective

To assess the outcome in severely ill patients with hematological malignancies who receive intravenous chemotherapy in an intensive care unit (ICU) for a life-threatening malignancy-related complication.

Design

Retrospective observational study of prospectively collected data.

Patients

All 37 critically ill patients with hematological malignancies who received intravenous chemotherapy in the ICU between January 1997 and March 2005 (mean age 46±19 years; mean APACHE II 23±7).

Measurements and results

Thirty-seven (69%) patients received chemotherapy because of extensive disease with organ involvement (54%), extensive disease without organ involvement (19%), severe disseminated intravascular coagulation (11%), and other reasons (16%). In 41% there was concomitant infection when chemotherapy was initiated, in 86% a high-grade malignancy, and 30% relapsing disease. Twenty-three (62%) patients received mechanical ventilation at the moment of or soon after initiation of chemotherapy for a median duration of 5 days (1–67), and 24% underwent renal replacement therapy during ICU stay. Only ventilation was associated with in-hospital mortality (odds ratio 9.3). ICU, in-hospital, and 6-month mortality rates in nonventilated vs. ventilated patients were 7% and 48%, 14% and 61%, and 54% and 74%, respectively.

Conclusions

Starting chemotherapy in the ICU for a life-threatening malignancy related complication can be lifesaving even when infection or organ failure is present

Keywords

Hematological Intensive care unit Intravenous chemotherapy Malignancy 

Supplementary material

supp.pdf (54 kb)
(PDF 55 KB)

References

  1. 1.
    Rubenfeld GD, Crawford SW (1996) Withdrawing life support from mechanically ventilated recipients of bone marrow transplants: a case for evidence-based guidelines. Ann Intern Med 8:625–633Google Scholar
  2. 2.
    Azoulay E, Recher C, Alberti C, Soufir L, Leleu G, Le Gall JR, Fermand JP, Schlemmer B (1999) Changing use of intensive care for hematological patients: the example of multiple myeloma. Intensive Care Med 25:1395–1401CrossRefPubMedGoogle Scholar
  3. 3.
    Azoulay E, Albertti C, Bornstain C, Leleu G, Moreau D, Recher C, Chevret S, Le Gall JR, Brochard L, Schlemmer B (2001) Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 29:519–525CrossRefPubMedGoogle Scholar
  4. 4.
    Larché J, Azouley E, Fieux F, Mesnard L, Moreau D, Thiery G, Darmon M, Le Gall JR, Schlemmer B (2003) Improved survival of critically ill cancer patients with septic shock. Intensive Care Med 29:1688–1695CrossRefPubMedGoogle Scholar
  5. 5.
    Staudinger T, Stoiser B, Müllner M, Locker GJ, Laczika K, Knapp S, Burgmann H, Wilfing A, Kolfer J, Thalhammer F, Frass M (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the Intensive care Unit. Crit Care Med 28:1322–1328CrossRefPubMedGoogle Scholar
  6. 6.
    Benoit DD, Vandewoude KH, Decruyenaere JM, Hoste EA, Colardyn FA (2003) Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med 31:104–112CrossRefPubMedGoogle Scholar
  7. 7.
    Depuydt PO, Benoit DD, Vandewoude K, Decruyenaere J, Colardyn F (2004) Outcome in non-invasively and invasively ventilated hematologic patients with acute respiratory failure. Chest 126:1299–1306CrossRefPubMedGoogle Scholar
  8. 8.
    Benoit DD, Hoste EA, Depuydt PO, Offner FC, Lameire NH, Vandewoude KH, Dhondt AW, Noens LA, Decruyenare JM (2005) Outcome in critically ill medical patients treated with renal replacement therapy for acute renal failure: comparison between patients with and those without haematological malignancies. Nephrol Dial Transplant 20:552–558CrossRefPubMedGoogle Scholar
  9. 9.
    Benoit DD, Depuydt PO, Peleman RA, Offner FC, Vandewoude KH, Vogelaers DP, Blot SI, Noens LA, Colardyn FA, Decruyenaere JM (2005) Documented and clinically suspected bacterial infection precipitating ICU admission in patients with hematologic malignancies: impact on outcome. Intensive Care Med 31:934–942CrossRefPubMedGoogle Scholar
  10. 10.
    Azoulay E, Thièry G, Chevret S, Moreau D, Darmon M, Bergeron A, Yang K, Meignin V, Ciroldi M, Le Gall JR, Tazi A, Schlemmer B (2004) The prognosis of acute respiratory failure in critically ill cancer patients. Medicine (Baltimore) 83:6:360–370Google Scholar
  11. 11.
    Soares M, Salluh JI, Spector N, Rocco JR (2005) Characteristics and outcome of cancer patients requiring mechanical ventilatory support >24 h. Crit Care Med 33:520–526CrossRefPubMedGoogle Scholar
  12. 12.
    Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP (2001) Noninvasive ventilation in immunosupressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487CrossRefPubMedGoogle Scholar
  13. 13.
    Sculier JP, Markiewicz E (1991) Medical cancer-patients and intensive-care. Anticancer Res 11:2171–2174PubMedGoogle Scholar
  14. 14.
    Kirch C, Blot F, Fizazi K, Raynard B, Theodore C, Nitenberg G (2003) Acute respiratory distress syndrome after chemotherapy for lung metastases from non-seminomatous germ-cell tumors. Support Care Cancer 11:575–580CrossRefPubMedGoogle Scholar
  15. 15.
    Jennens RR, Rosenthal MA, Michell P, Presneill JJ (2002) Outcome of patients admitted to the intensive care unit with newly diagnosed small cell lung cancer. Lung Cancer 38:291–296CrossRefPubMedGoogle Scholar
  16. 16.
    Azoulay E, Fieux F, Moreau D, Thiery G, Rousselot P, Parrot A, Le Gall JR, Dombret H, Schlemmer B (2003) Acute monocytic leukaemia presenting as respiratory failure. Am J Respir Crit Care Med 167:1329–1333CrossRefPubMedGoogle Scholar
  17. 17.
    Levy MM, Fink MP, Marschall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G for the International Sepsis Definitions Conference (2003) 2001 SCCM/ESICM/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med 29:530–538PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Dominique D. Benoit
    • 1
  • Pieter O. Depuydt
    • 1
  • Koenraad H. Vandewoude
    • 1
  • Fritz C. Offner
    • 2
  • Tom Boterberg
    • 3
  • Carole A. De Cock
    • 1
  • Lucien A. Noens
    • 2
  • Ann M. Janssens
    • 2
  • Johan M. Decruyenaere
    • 1
  1. 1.Department of Intensive Care MedicineGhent University HospitalGhentBelgium
  2. 2.Department of HematologyGhent University HospitalGhentBelgium
  3. 3.Department of RadiotherapyGhent University HospitalGhentBelgium

Personalised recommendations