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Intensive Care Medicine

, 35:512 | Cite as

Continued survival gains in recent years among critically ill myeloma patients

  • Vincent Peigne
  • Kateřina Rusinová
  • Lionel Karlin
  • Michael Darmon
  • Jean-Paul Fermand
  • Benoît Schlemmer
  • Élie AzoulayEmail author
Original

Abstract

Objective

Therapeutic advances have improved survival in patients with myeloma (MM) over the past decade. We investigated whether survival has also improved in critically ill myeloma patients.

Design

Retrospective study.

Setting

Intensive care unit.

Patient

Consecutive myeloma patients admitted to a teaching hospital ICU between 1990 and 2006. We compared three year-of-admission groups (1990–1995, 1996–2001, and 2002–2006) that matched changes in myeloma treatment (chemotherapy only, stem cell transplantation, and new molecules, respectively).

Intervention

None.

Measurements and main results

We included 196 patients. Reasons for ICU admission and patient characteristics were similar across groups; however, less use of conventional chemotherapy and radiotherapy and greater use of steroids were noted in the more recent periods. Over time, vasopressors and invasive mechanical ventilation were used decreasingly, and noninvasive ventilation increasingly, to treat acute respiratory failure. Hospital mortality decreased from 75% in 1990–1995 to 49% in 1996–2001 and 40% in 2002–2006 (= 0.0007). Mortality was associated with poor performance status [OR 2.27, 95% CI (1.04–4.99)], need for mechanical ventilation [OR 4.33, 95% CI (1.86–10.10)], need for vasopressors [OR 2.57, 95% CI (1.12–5.86)], and admission for an event related to myeloma progression [OR 2.77, 95% CI (1.13–6.79)]. ICU admission within 48 h after hospital admission was associated with lower mortality [OR 0.28, 95% CI (0.19–0.89)].

Conclusion

Hospital mortality decreased significantly over the last 15 years in myeloma patients admitted to the ICU. Risk factors for death were organ failure and poor chronic health status. Early ICU admission was associated with lower mortality, suggesting opportunities for further improving survival.

Keywords

Bone marrow transplantation Acute respiratory failure Noninvasive mechanical ventilation Sepsis Early admission 

Notes

Acknowledgments

This study was supported by a grant from the Assistance-Publique Hôpitaux de Paris (AOM 04139), a nonprofit publicly funded institution.

Conflict of interest statement

None of the authors have any conflict of interest to declare.

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Vincent Peigne
    • 1
  • Kateřina Rusinová
    • 1
  • Lionel Karlin
    • 2
  • Michael Darmon
    • 1
  • Jean-Paul Fermand
    • 2
  • Benoît Schlemmer
    • 1
  • Élie Azoulay
    • 1
    • 3
    Email author
  1. 1.Medical ICUAP-HP, Hôpital Saint-LouisParisFrance
  2. 2.Department of ImmunologyAP-HP, Hôpital Saint-LouisParisFrance
  3. 3.Service de Réanimation MédicaleHôpital Saint-Louis et Université Paris 7ParisFrance

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