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Outcome of allogeneic hematopoietic stem cell transplant recipients admitted to the intensive care unit with a focus on haploidentical graft and sequential conditioning regimen: results of a retrospective study

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Abstract

Haploidentical transplantation has extended the availability of allogeneic hematopoietic stem cell transplant (alloHCT) to almost all patients. Sequential conditioning regimens have been proposed for the treatment of hematological active disease. Whether these new transplantation procedures affect the prognosis of critically ill alloHCT recipients remains unknown. We evaluated this question in a retrospective study including consecutive alloHCT patients admitted to the intensive care unit of a tertiary academic center from 2010 to 2017. During the study period, 412 alloHCTs were performed and 110 (27%) patients—median age 55 (36–64) years—were admitted to ICU in a median time of 58.5 (14–245) days after alloHCT. Twenty-nine (26%) patients had received a haploidentical graft and 34 (31%) a sequential conditioning. Median SOFA score was 9 (6–11). Invasive mechanical ventilation (MV) was required in 61 (55%) patients. Fifty-six (51%) patients died in the hospital. Independent factors associated with in-hospital mortality were as follows: MV (OR=8.44 [95% CI 3.30–23.19], p<0.001), delta SOFA between day 3 and day 1 (OR=1.60 [95% CI 1.31–2.05], p<0.0001), and sequential conditioning (OR=3.7 [95% CI 1.14–12.92], p=0.033). Sequential conditioning was also independently associated with decreased overall survival (HR=1.86 [95% CI 1.05–3.31], p=0.03). Other independent factors associated with reduced overall survival were HCT-specific comorbidity index ≥2 (HR=1.76 [95% CI 1.10–2.84], p=0.02), acute GVHD grade ≥2 (HR=1.88 [95% CI 1.14–3.10], p=0.01), MV (HR=2.37 [95% CI 1.38–4.07, p=0.002), and vasopressors (HR=2.21 [95% CI 1.38–3.54], p=0.001). Haploidentical transplantation did not affect outcome. Larger multicenter studies are warranted to confirm these results.

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Abbreviations

AlloHCT:

Allogeneic hematopoietic cell transplantation

GHVD:

Graft-versus-host disease

HCT-CI:

Hematopoietic cell transplantation–specific comorbidity index

ICU:

Intensive care unit

IQR:

Interquartile range

MAC:

Myeloablative conditioning

RIC:

Reduced-intensity conditioning

TBI:

Total body irradiation

SOFA:

Sequential organ failure assessment

SAPS II:

Simplified acute physiology score II

95% CI:

95% confidence interval

AUC:

Area under curve

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The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, AP-HP, 184 rue du Faubourg Saint-Antoine, 75571, Paris, Cedex 12, France

    Viviane Gournay, Guillaume Dumas, Jean-Rémi Lavillegrand, Geoffroy Hariri, Tomas Urbina, Jean-Luc Baudel, Hafid Ait-Oufella, Eric Maury, Bertrand Guidet & Naïke Bigé

  2. Sorbonne Université, Université Pierre et Marie Curie, 75006, Paris, France

    Guillaume Dumas, Jean-Rémi Lavillegrand, Geoffroy Hariri, Tomas Urbina, Hafid Ait-Oufella, Eric Maury, Eolia Brissot, Ollivier Legrand, Florent Malard, Mohamad Mohty, Bertrand Guidet & Rémy Duléry

  3. Inserm U970, Paris Research Cardiovascular Center, Paris, France

    Hafid Ait-Oufella

  4. Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France

    Eolia Brissot, Ollivier Legrand, Florent Malard, Mohamad Mohty & Rémy Duléry

  5. UMRS 938, Inserm, Paris, France

    Eolia Brissot, Ollivier Legrand, Florent Malard, Mohamad Mohty & Rémy Duléry

  6. Inserm U1136, Paris, France

    Bertrand Guidet

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  1. Viviane Gournay
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Contributions

Conception and design: VG, GD, RD, and NB; acquisition, analysis, or interpretation of data: VG, GD, RD, and NB; drafting of manuscript and/or revising it for important intellectual content: VG, GD, RD, and NB; final approval of version to be published: VG, GD, JRL, GH, TU, JLB, HAO, EM, OL, EB, FM, BG, RD, and NB; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: VG and NB. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Naïke Bigé.

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Ethics approval and consent to participate

All patients signed an anonymous data-recording consent before alloHCT procedure. The hospital medico-administrative is declared to the national committee for protection of privacy (Commission Nationale de l’Informatique et des Libertés). The study has been approved by the Ethics Commission of the French Intensive Care Society (Société de Réanimation de Langue Française).

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Not applicable

Competing interests

FM, RD, and MM received honoraria for lectures from Keocyt and Sanofi, whose drugs were used to treat patients included in this study.

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Gournay, V., Dumas, G., Lavillegrand, JR. et al. Outcome of allogeneic hematopoietic stem cell transplant recipients admitted to the intensive care unit with a focus on haploidentical graft and sequential conditioning regimen: results of a retrospective study. Ann Hematol 100, 2787–2797 (2021). https://doi.org/10.1007/s00277-021-04640-7

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  • DOI: https://doi.org/10.1007/s00277-021-04640-7

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