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Successful allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia during respiratory failure and invasive mechanical ventilation

Erfolgreiche allogene Blutstammzelltransplantation bei akuter myeloischer Leukämie während respiratorischem Versagen und invasiver Beatmung

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Zusammenfassung

Die allogene hämatopoetische Stammzelltransplantation (HSCT) ist eine potentiell kurative Behandlungsoption für viele hämatologische Erkrankungen. Durch die Behandlungs-assoziierte Toxizität, schwere Infektionen und/oder die Spender-gegen-Empfänger-Reaktion (GvHD) kann es allerdings zum Auftreten von lebensbedrohlichen Komplikationen kommen. Wir berichten über eine 64-jährige Patientin mit sekundärer akuter myeloischer Leukämie (AML), bei der unter invasiver mechanischer Beatmung erfolgreich eine HSCT durchgeführt werden konnte. Die Patientin erhielt eine dosisreduzierte Konditionierungschemotherapie nach dem FLAMSA-Protokoll. Am Tag vor der geplanten HSCT kam es zum Auftreten eines respiratorischen Versagens, weshalb die Patientin nach einer akut notwendigen Intubation an die Intensivstation (ICU) transferiert wurde. Aufgrund der respiratorischen Verschlechterung musste die Stammzellinfusion verschoben werden. Nachdem die Patientin wiederum stabilisiert werden konnte, wurde die HSCT durchgeführt und die mechanische Beatmung für insgesamt 7 Tage vollzogen. Nach der hämatopoetischen Regeneration konnte die Patientin in gutem Allgemeinzustand am Tag 35 nach HSCT entlassen werden. Dieser Fallbericht zeigt, dass Intubation und Beatmung keine absoluten Kontraindikationen für die Durchführung einer HSCT bei Leukämiepatienten sind.

Summary

Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative treatment option for various hematologic disorders. However, life-threatening adverse events resulting from treatment-related toxicity, severe infections, and/or graft-versus-host disease (GvHD) can occur. We report on a 64-year-old patient suffering from secondary acute myeloid leukemia (AML) who underwent successful allogeneic HSCT while on invasive mandatory ventilation (IMV). The patient received reduced intensity conditioning (RIC) according to the FLAMSA-protocol. Acute respiratory failure occurred one day before scheduled HSCT. Following emergency endotracheal intubation the patient was transferred to the intensive care unit (ICU). Because of respiratory deterioration, stem cell infusion was postponed. After stabilization of respiratory parameters, HSCT was performed during IMV which was continued for seven days. Following hematopoietic regeneration the patient was discharged in good condition on day 35 after HSCT. This case illustrates that intubation and mechanical ventilation do not necessarily exclude leukemic patients from HSCT.

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References

  • Soubani AO, Kseibi E, Bander JJ, Klein JL, Khanchandani G, Ahmed HP, Guzman JA. Outcome and prognostic factors of hematopoietic stem cell transplantation recipients admitted to a medical ICU. Chest 2004;126:1604–11

    Article  PubMed  Google Scholar 

  • Pène F, Aubron C, Azoulay E, Blot F, Thiéry G, Raynard B, Schlemmer B, Nitenberg G, Buzyn A, Arnaud P, Socié G, Mira JP. Outcome of critically ill allogeneic hematopoietic stem-cell transplantation recipients: a reappraisal of indications for organ failure supports. J Clin Oncol 2006;24:643–9

    Article  PubMed  Google Scholar 

  • Jackson SR, Tweeddale MG, Barnett MJ, Spinelli JJ, Sutherland HJ, Reece DE, Klingemann HG, Nantel SH, Fung HC, Toze CL, Phillips GL, Shepherd JD. Admission of bone marrow transplant recipients to the intensive care unit: outcome, survival and prognostic factors. Bone Marrow Transplant 1998;21:697–704

    Article  CAS  PubMed  Google Scholar 

  • Kew AK, Couban S, Patrick W, Thompson K, White D. Outcome of hematopoietic stem cell transplant recipients admitted to the intensive care unit. Biol Blood Marrow Transplant 2006;12:301–5

    Article  PubMed  Google Scholar 

  • Crawford SW, Petersen FB. Long-term survival from respiratory failure after marrow transplantation for malignancy. Am Rev Respir Dis 1992;145:510–4

    Article  CAS  PubMed  Google Scholar 

  • Rubenfeld GD, Crawford SW. Withdrawing life support from mechanically ventilated recipients of bone marrow transplants: a case for evidence-based guidelines. Ann Intern Med 1996;125:625–33

    Article  CAS  PubMed  Google Scholar 

  • Faber-Langendoen K, Caplan AL, McGlave PB. Survival of adult bone marrow transplant patients receiving mechanical ventilation: a case for restricted use. Bone Marrow Transplant 1993;12:501–7

    CAS  PubMed  Google Scholar 

  • Kotloff RM, Ahya VN, Crawford SW. Pulmonary complications of solid organ and hematopoietic stem cell transplantation. Am J Respir Crit Care Med 2004;170:22–48

    Article  PubMed  Google Scholar 

  • Ho VT, Weller E, Lee SJ, Alyea EP, Antin JH, Soiffer RJ. Prognostic factors for early severe pulmonary complications after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2001;7:223–9

    Article  CAS  PubMed  Google Scholar 

  • Bach PB, Schrag D, Nierman DM, Horak D, White P Jr, Young JW, Groeger JS. Identification of poor prognostic features among patients requiring mechanical ventilation after hematopoietic stem cell transplantation. Blood 2001;98:3234–40

    Article  CAS  PubMed  Google Scholar 

  • Price KJ, Thall PF, Kish SK, Shannon VR, Andersson BS. Prognostic indicators for blood and marrow transplant patients admitted to an intensive care unit. Am J Respir Crit Care Med 1998;158:876–84

    Article  CAS  PubMed  Google Scholar 

  • Hilbert G, Gruson D, Vargas F, Valentino R, Chene G, Boiron JM, Pigneux A, Reiffers J, Gbikpi-Benissan G, Cardinaud JP. Noninvasive continuous positive airway pressure in neutropenic patients with acute respiratory failure requiring intensive care unit admission. Crit Care Med 2000;28:3185–90

    Article  CAS  PubMed  Google Scholar 

  • Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 2001;344:481–7

    Article  CAS  PubMed  Google Scholar 

  • Rabitsch W, Staudinger T, Locker GJ, Köstler WJ, Laczika K, Frass M, Knoebl P, Greinix HT, Kalhs P, Keil F. Respiratory failure after stem cell transplantation: improved outcome with non-invasive ventilation. Leuk Lymphoma 2005;46:1151–7

    Article  PubMed  Google Scholar 

  • Rabitsch W, Staudinger T, Brugger SA, Reiter E, Keil F, Herold C, Lechner K, Greinix HT, Kalhs P. Successful management of adult respiratory distress syndrome (ARDS) after high-dose chemotherapy and peripheral blood progenitor cell rescue by non-invasive ventilatory support. Bone Marrow Transplant 1998;21:1067–9

    Article  CAS  PubMed  Google Scholar 

  • Azoulay E, Alberti C, Bornstain C, Leleu G, Moreau D, Recher C, Chevret S, Le Gall JR, Brochard L, Schlemmer B. Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 2001;29:519–25

    Article  CAS  PubMed  Google Scholar 

  • Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol 1994;47:1245–51

    Article  CAS  PubMed  Google Scholar 

  • Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG, Storer B. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005;106:2912–9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Khassawneh BY, White P Jr, Anaissie EJ, Barlogie B, Hiller FC. Outcome from mechanical ventilation after autologous peripheral blood stem cell transplantation. Chest 2002;121:185–8

    Article  PubMed  Google Scholar 

  • Hamadah A, McDiarmid SA, Huebsch LB, Patel R, Allan DS. Management of patients transferred to the ICU during the conditioning phase of allogeneic hematopoietic stem cell transplantation. Intensive Care Med 2009;35:2002–3

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine I, Bone Marrow Transplantation Unit, Medical University of Vienna, Vienna, Austria

    Alexandra Boehm, Werner Rabitsch & Viktoria Siersch

  2. Department of Internal Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna, Austria

    Gottfried J. Locker, Oliver Robak, Klaus F. Laczika, Thomas Staudinger & Andja Bojic

  3. Department for Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria

    Nina Worel

  4. Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria

    Peter Valent & Wolfgang R. Sperr

  5. Ludwig Boltzmann Cluster Oncology, Vienna, Austria

    Peter Valent

Authors
  1. Alexandra Boehm
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  2. Werner Rabitsch
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  3. Gottfried J. Locker
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  4. Nina Worel
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  5. Oliver Robak
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  6. Klaus F. Laczika
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  7. Thomas Staudinger
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  8. Andja Bojic
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  9. Viktoria Siersch
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  10. Peter Valent
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  11. Wolfgang R. Sperr
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Corresponding author

Correspondence to Wolfgang R. Sperr.

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Boehm, A., Rabitsch, W., Locker, G. et al. Successful allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia during respiratory failure and invasive mechanical ventilation. Wien Klin Wochenschr 123, 354–358 (2011). https://doi.org/10.1007/s00508-011-1590-7

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  • DOI: https://doi.org/10.1007/s00508-011-1590-7

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