Intensive Care Medicine

, Volume 44, Issue 9, pp 1483–1492 | Cite as

Improved short- and long-term outcome of allogeneic stem cell recipients admitted to the intensive care unit: a retrospective longitudinal analysis of 942 patients

  • Catherina Lueck
  • Michael Stadler
  • Christian Koenecke
  • Marius M. Hoeper
  • Elke Dammann
  • Andrea Schneider
  • Jan T. Kielstein
  • Arnold Ganser
  • Matthias Eder
  • Gernot BeutelEmail author



Intensive care unit (ICU) admission of allogeneic hematopoietic stem cell transplant (HSCT) recipients is associated with relatively poor outcome. Since longitudinal data on this topic remains scarce, we analyzed reasons for ICU admission as well as short- and long-term outcome of critically ill HSCT recipients.


A total of 942 consecutive adult patients were transplanted at Hannover Medical School from 2000 to 2013. Of those, 330 patients were at least admitted once to the ICU and included in this retrospective study. To analyze time-dependent improvements, we separately compared patient characteristics as well as reasons and outcome of ICU admission for the periods 2000–2006 and 2007–2013.


The main reasons for ICU admission were acute respiratory failure (ARF) in 35%, severe sepsis/septic shock in 23%, and cardiac problems in 18%. ICU admission was clearly associated with shortened survival (p < 0.001), but survival of ICU patients after hospital discharge reached 44% up to 5 years and was comparable to that of non-ICU HSCT patients. When ICU admission periods were compared, patients were older (48 vs. 52 years; p < 0.005) and the percentage of ARF as leading cause for ICU admission decreased from 43% in the first to 30% in the second period. Over time ICU and hospital survival improved from 44 to 60% (p < 0.01) and from 26 to 43% (p < 0.01), respectively. The 1- and 3-year survival rate after ICU admission increased significantly from 14 to 32% and from 11 to 23% (p < 0.01).


Besides ARF and septic shock, cardiac events were especially a major reason for ICU admission. Both short- and long-term survival of critically ill HSCT patients has improved significantly in recent years, and survival of HSCT recipients discharged from hospital is not significantly affected by a former ICU stay.


Hematopoietic stem cell transplantation Intensive care Outcome Respiratory failure 



Acute lymphoblastic leukemia


Acute myeloid leukemia


Acute physiology and chronic health evaluation II


Acute respiratory distress syndrome


Acute respiratory failure


Chronic lymphatic leukemia


Chronic myeloid leukemia


Concomitant organ dysfunction


European Society for Blood and Marrow Transplantation


Graft-versus-host disease


Hematopoetic stem cell transplantation


Intensive care unit


Initial diagnosis


Interquartile range


Invasive mechanical ventilation


Leading organ dysfunction


Life-sustaining therapies


Myelodysplastic syndrome


Multiple organ dysfunction syndrome


Myeloproliferative neoplasm


Non-invasive ventilations


Peripheral blood stem cells


Compliance with ethical standards

Informed consent and ethical approval

Informed consent for data collection was obtained from all individual participants (according to EBMT Registry forms) and approved by the local ethics committee. Our study was performed in accordance with the 1964 Declaration of Helsinki and its later amendments.

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

134_2018_5347_MOESM1_ESM.jpg (110 kb)
Supplementary material 1 (JPEG 110 kb)
134_2018_5347_MOESM2_ESM.jpeg (456 kb)
Supplementary material 2 (JPEG 456 kb)
134_2018_5347_MOESM3_ESM.jpeg (46 kb)
Supplementary material 3 (JPEG 46 kb)
134_2018_5347_MOESM4_ESM.jpeg (45 kb)
Supplementary material 4 (JPEG 45 kb)


  1. 1.
    Gratwohl A, Pasquini MC, Aljurf M, Atsuta Y, Baldomero H, Foeken L, Gratwohl M, Bouzas LF, Confer D, Frauendorfer K, Gluckman E, Greinix H, Horowitz M, Iida M, Lipton J, Madrigal A, Mohty M, Noel L, Novitzky N, Nunez J, Oudshoorn M, Passweg J, van Rood J, Szer J, Blume K, Appelbaum FR, Kodera Y, Niederwieser D, Worldwide Network for B, Marrow T (2015) One million haemopoietic stem-cell transplants: a retrospective observational study. Lancet Haematol 2:e91–e100CrossRefPubMedGoogle Scholar
  2. 2.
    Denardo SJ, Oye RK, Bellamy PE (1989) Efficacy of intensive care for bone marrow transplant patients with respiratory failure. Crit Care Med 17:4–6CrossRefPubMedGoogle Scholar
  3. 3.
    Lengline E, Chevret S, Moreau AS, Pene F, Blot F, Bourhis JH, Buzyn A, Schlemmer B, Socie G, Azoulay E (2015) Changes in intensive care for allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transplant 50:840–845CrossRefPubMedGoogle Scholar
  4. 4.
    Mokart D, Granata A, Crocchiolo R, Sannini A, Chow-Chine L, Brun JP, Bisbal M, Faucher M, Faucher C, Blache JL, Castagna L, Furst S, Blaise D (2015) Allogeneic hematopoietic stem cell transplantation after reduced intensity conditioning regimen: outcomes of patients admitted to intensive care unit. J Crit Care 30:1107–1113CrossRefPubMedGoogle Scholar
  5. 5.
    Pene F, Aubron C, Azoulay E, Blot F, Thiery G, Raynard B, Schlemmer B, Nitenberg G, Buzyn A, Arnaud P, Socie G, Mira JP (2006) Outcome of critically ill allogeneic hematopoietic stem-cell transplantation recipients: a reappraisal of indications for organ failure supports. J Clin Oncol 24:643–649CrossRefPubMedGoogle Scholar
  6. 6.
    Platon L, Amigues L, Ceballos P, Fegueux N, Daubin D, Besnard N, Larcher R, Landreau L, Agostini C, Machado S, Jonquet O, Klouche K (2016) A reappraisal of ICU and long-term outcome of allogeneic hematopoietic stem cell transplantation patients and reassessment of prognosis factors: results of a 5-year cohort study (2009–2013). Bone Marrow Transplant 51:256–261CrossRefPubMedGoogle Scholar
  7. 7.
    Scales DC, Thiruchelvam D, Kiss A, Sibbald WJ, Redelmeier DA (2008) Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis. Crit Care 12:R77CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Torrecilla C, Cortes JL, Chamorro C, Rubio JJ, Galdos P, Dominguez de Villota E (1988) Prognostic assessment of the acute complications of bone marrow transplantation requiring intensive therapy. Intensive Care Med 14:393–398CrossRefPubMedGoogle Scholar
  9. 9.
    Benz R, Schanz U, Maggiorini M, Seebach JD, Stussi G (2014) Risk factors for ICU admission and ICU survival after allogeneic hematopoietic SCT. Bone Marrow Transplant 49:62–65CrossRefPubMedGoogle Scholar
  10. 10.
    Afessa B, Tefferi A, Dunn WF, Litzow MR, Peters SG (2003) Intensive care unit support and acute physiology and chronic health evaluation III performance in hematopoietic stem cell transplant recipients. Crit Care Med 31:1715–1721CrossRefPubMedGoogle Scholar
  11. 11.
    Jackson SR, Tweeddale MG, Barnett MJ, Spinelli JJ, Sutherland HJ, Reece DE, Klingemann HG, Nantel SH, Fung HC, Toze CL, Phillips GL, Shepherd JD (1998) Admission of bone marrow transplant recipients to the intensive care unit: outcome, survival and prognostic factors. Bone Marrow Transplant 21:697–704CrossRefPubMedGoogle Scholar
  12. 12.
    Gooley TA, Chien JW, Pergam SA, Hingorani S, Sorror ML, Boeckh M, Martin PJ, Sandmaier BM, Marr KA, Appelbaum FR, Storb R, McDonald GB (2010) Reduced mortality after allogeneic hematopoietic-cell transplantation. N Engl J Med 363:2091–2101CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Zimmerman JE, Kramer AA, Knaus WA (2013) Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Crit Care 17:R81CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Azoulay E, Lemiale V, Mokart D, Pene F, Kouatchet A, Perez P, Vincent F, Mayaux J, Benoit D, Bruneel F, Meert AP, Nyunga M, Rabbat A, Darmon M (2014) Acute respiratory distress syndrome in patients with malignancies. Intensive Care Med 40:1106–1114CrossRefPubMedGoogle Scholar
  15. 15.
    Pene F, Percheron S, Lemiale V, Viallon V, Claessens YE, Marque S, Charpentier J, Angus DC, Cariou A, Chiche JD, Mira JP (2008) Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Crit Care Med 36:690–696CrossRefPubMedGoogle Scholar
  16. 16.
    Azoulay E, Mokart D, Pene F, Lambert J, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Laisne LM, Rabbat A, Lebert C, Perez P, Chaize M, Renault A, Meert AP, Benoit D, Hamidfar R, Jourdain M, Darmon M, Schlemmer B, Chevret S, Lemiale V (2013) Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium-a groupe de recherche respiratoire en reanimation onco-hematologique study. J Clin Oncol 31:2810–2818CrossRefPubMedGoogle Scholar
  17. 17.
    Mayer S, Pastores SM, Riedel E, Maloy M, Jakubowski AA (2016) Short- and long-term outcomes of adult allogeneic hematopoietic stem cell transplant patients admitted to the intensive care unit in the peritransplant period. Leuk Lymphoma 58:382–390CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Lueck CSM, Koenecke C, Hoeper MM, Dammann E, Schneider AS, Kielstein JT, Ganser A, Eder M, Beutel G (2016) “Outcome of allogeneic stem cell recipients admitted to the ICU-a single center analysis of 942 patients“-Jahrestagung der Deutschen, Osterreichischen und Schweizerischen Gesellschaften fur Hamatologie und Medizinische Onkologie Leipzig, 14–18. Oktober, Abstracts. Oncol Res Treat 39(Suppl 3):1–348Google Scholar
  19. 19.
    Ullmann AJ, Schmidt-Hieber M, Bertz H, Heinz WJ, Kiehl M, Kruger W, Mousset S, Neuburger S, Neumann S, Penack O, Silling G, Vehreschild JJ, Einsele H, Maschmeyer G, Infectious Diseases Working Party of the German Society for H, Medical O, the D-K (2016) Infectious diseases in allogeneic haematopoietic stem cell transplantation: prevention and prophylaxis strategy guidelines 2016. Ann Hematol 95:1435–1455CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Thomas ED, Storb R, Clift RA, Fefer A, Johnson L, Neiman PE, Lerner KG, Glucksberg H, Buckner CD (1975) Bone-marrow transplantation (second of two parts). N Engl J Med 292:895–902CrossRefPubMedGoogle Scholar
  21. 21.
    Gratwohl A, Stern M, Brand R, Apperley J, Baldomero H, de Witte T, Dini G, Rocha V, Passweg J, Sureda A, Tichelli A, Niederwieser D, European Group for B, Marrow T, the European Leukemia N (2009) Risk score for outcome after allogeneic hematopoietic stem cell transplantation: a retrospective analysis. Cancer 115:4715–4726CrossRefPubMedGoogle Scholar
  22. 22.
    DA Karnofsky AW, Craver LF, Burchenal JH (1948) The use of the nitrogen mustards in the palliative treatment of carcinoma—with particular reference to bronchogenic carcinoma. Cancer 1:634–656CrossRefGoogle Scholar
  23. 23.
    Outcomes KDIG (2012) Section 2: AKI definition. Kidney Int Suppl (2011) 2:19–36Google Scholar
  24. 24.
    Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963CrossRefPubMedGoogle Scholar
  25. 25.
    Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, International sepsis definitions C (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med 29:530–538Google Scholar
  26. 26.
    Townsend WM, Holroyd A, Pearce R, Mackinnon S, Naik P, Goldstone AH, Linch DC, Peggs KS, Thomson KJ, Singer M, Howell DC, Morris EC (2013) Improved intensive care unit survival for critically ill allogeneic haematopoietic stem cell transplant recipients following reduced intensity conditioning. Br J Haematol 161:578–586CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Azoulay E, Soares M, Darmon M, Benoit D, Pastores S, Afessa B (2011) Intensive care of the cancer patient: recent achievements and remaining challenges. Ann Intensive Care 1:5CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European society of intensive care medicine. Intensive Care Med 22:707–710CrossRefPubMedGoogle Scholar
  29. 29.
    Saillard C, Blaise D, Mokart D (2016) Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis. Bone Marrow Transplant 51:1050–1061CrossRefPubMedGoogle Scholar
  30. 30.
    Orvain C, Beloncle F, Hamel JF, Thepot S, Mercier M, Kouatchet A, Farhi J, Francois S, Guardiola P, Asfar P, Hunault-Berger M, Mercat A, Ifrah N, Tanguy-Schmidt A (2017) Different impact of the number of organ failures and graft-versus-host disease on the outcome of allogeneic stem cell transplantation recipients requiring intensive care. Transplantation 101:437–444CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Catherina Lueck
    • 1
    • 5
  • Michael Stadler
    • 1
  • Christian Koenecke
    • 1
  • Marius M. Hoeper
    • 2
  • Elke Dammann
    • 1
  • Andrea Schneider
    • 3
  • Jan T. Kielstein
    • 4
  • Arnold Ganser
    • 1
  • Matthias Eder
    • 1
  • Gernot Beutel
    • 1
    • 5
    Email author
  1. 1.Department for Hematology, Hemostasis, Oncology and Stem Cell TransplantationHannover Medical SchoolHannoverGermany
  2. 2.Interdisciplinary Internal Intensive Care Unit, Department for Respiratory Diseases and German Centre of Lung Research (DZL)Hannover Medical SchoolHannoverGermany
  3. 3.Interdisciplinary Internal Intensive Care Unit, Department for Gastroenterology, Hepatology, and EndocrinologyHannover Medical SchoolHannoverGermany
  4. 4.Interdisciplinary Internal Intensive Care Unit, Department for Nephrology and HypertensionHannover Medical SchoolBraunschweigGermany
  5. 5.Intensive Care in Hematologic and Oncologic Patients (iCHOP)HannoverGermany

Personalised recommendations