Skip to main content

Long-term outcomes in patients treated in the intensive care unit after hematopoietic stem cell transplantation

Abstract

The number of patients who are successfully discharged from the intensive care unit (ICU) after hematopoietic stem cell transplantation (HSCT) remains limited. Most previous studies have evaluated short-term outcomes using ICU mortality; there have been comparatively fewer reports of long-term outcomes. We retrospectively analyzed 39 HSCT patients admitted to the ICU for the first time between April 2008 and July 2014. Performance status was evaluated in four long-term survivors in July 2016. Median age at ICU admission was 54 years (range 30–68). In total, 33 patients (70.2%) required mechanical ventilation and 31 patients (66%) required dialysis. The median OS from first ICU admission was 41 days (95% confidence interval [CI]: 22–64) and the 1-year survival rate was 12.8% (95% CI 4.7–25.2). No statistically significant factors were associated with short-term outcomes. Among long-term outcomes, a second or subsequent HSCT and neutropenia at ICU admission were significant risk factors. Four of 10 ICU survivors have survived with good performance status for a median of 1994 (1203–2633) days. Our results suggest that the number of prior transplants and neutropenia at ICU admission may influence OS.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Copelan EA. Hematopoietic stem-cell transplantation. N Engl J Med. 2006;354:1813–26.

    CAS  Article  Google Scholar 

  2. Gooley TA, Chien JW, Pergam SA, Hingorani S, Sorror ML, Boeckh M, et al. Reduced mortality after allogeneic hematopoietic-cell transplantation. N Engl J Med. 2010;363:2091–101.

    CAS  Article  Google Scholar 

  3. Huaringa AJ, Leyva FJ, Giralt SA, Blanco J, Signes-Costa J, Velarde H, et al. Outcome of bone marrow transplantation patients requiring mechanical ventilation. Crit Care Med. 2000;28:1014–7.

    CAS  Article  Google Scholar 

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

    CAS  Article  Google Scholar 

  5. Gilbert C, Vasu TS, Baram M. Use of mechanical ventilation and renal replacement therapy in critically ill hematopoietic stem cell transplant recipients. Biol Blood Marrow Transpl. 2013;19:321–4.

    Article  Google Scholar 

  6. Lengline E, Chevret S, Moreau AS, Pene F, Blot F, Bourhis JH, et al. Changes in intensive care for allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transpl. 2015;50:840–5.

    CAS  Article  Google Scholar 

  7. Pene F, Aubron C, Azoulay E, Blot F, Thiery G, Raynard B, et al. 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  Google Scholar 

  8. Townsend WM, Holroyd A, Pearce R, Mackinnon S, Naik P, Goldstone AH, et al. Improved intensive care unit survival for critically ill allogeneic haematopoietic stem cell transplant recipients following reduced intensity conditioning. Br J Haematol. 2013;161:578–86.

    Article  Google Scholar 

  9. Mokart D, Granata A, Crocchiolo R, Sannini A, Chow-Chine L, Brun JP, et al. Allogeneic hematopoietic stem cell transplantation after reduced intensity conditioning regimen: Outcomes of patients admitted to intensive care unit. J Crit Care. 2015;30:1107–13.

    Article  Google Scholar 

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

    CAS  Article  Google Scholar 

  11. Bayraktar UD, Shpall EJ, Liu P, Ciurea SO, Rondon G, de Lima M, et al. Hematopoietic cell transplantation-specific comorbidity index predicts inpatient mortality and survival in patients who received allogeneic transplantation admitted to the intensive care unit. J Clin Oncol. 2013;31:4207–14.

    Article  Google Scholar 

  12. Platon L, Amigues L, Ceballos P, Fegueux N, Daubin D, Besnard N, et al. 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 Transpl. 2016;51:256–61.

    CAS  Article  Google Scholar 

  13. Merz TM, Schar P, Buhlmann M, Takala J, Rothen HU. Resource use and outcome in critically ill patients with hematological malignancy: a retrospective cohort study. Crit Care. 2008;12:R75.

    Article  Google Scholar 

  14. Stricker K, Rothen HU, Takala J. Resource use in the ICU: short- vs. long-term patients. Acta Anaesthesiol Scand. 2003;47:508–15.

    CAS  Article  Google Scholar 

  15. Kim SW, Kami M, Urahama N, Yamamoto R, Hori A, Imataki O, et al. Feasibility of acute physiology and chronic health evaluation (APACHE) II and III score-based screening in patients receiving allogeneic hematopoietic stem-cell transplantation. Transplantation. 2003;75:566–70.

    Article  Google Scholar 

  16. Gilli K, Remberger M, Hjelmqvist H, Ringden O, Mattsson J. Sequential Organ Failure Assessment predicts the outcome of SCT recipients admitted to intensive care unit. Bone Marrow Transpl. 2010;45:682–8.

    CAS  Article  Google Scholar 

  17. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013;48:452–8.

    CAS  Article  Google Scholar 

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

    Article  Google Scholar 

  19. Escobar K, Rojas P, Ernst D, Bertin P, Nervi B, Jara V, et al. Admission of hematopoietic cell transplantation patients to the intensive care unit at the Pontificia Universidad Catolica de Chile Hospital. Biol Blood Marrow Transpl. 2015;21:176–9.

    Article  Google Scholar 

  20. Saillard C, Blaise D, Mokart D. Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis. Bone Marrow Transpl. 2016;51:1050–61.

    CAS  Article  Google Scholar 

  21. Yang TM, Wang PN, Kao KC, Huang CC, Tsai YH, Hsieh MJ. Outcome of hematopoietic stem cell recipients who were mechanically ventilated and admitted to intensive care units. J Formos Med Assoc. 2007;106:295–301.

    Article  Google Scholar 

  22. Azoulay E, Mokart D, Pene F, Lambert J, Kouatchet A, Mayaux J, et al. 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. 2013;31:2810–8.

    Article  Google Scholar 

  23. Hayani O, Al-Beihany A, Zarychanski R, Chou A, Kharaba A, Baxter A, et al. Impact of critical care outreach on hematopoietic stem cell transplant recipients: a cohort study. Bone Marrow Transpl. 2011;46:1138–44.

    CAS  Article  Google Scholar 

  24. Afessa B, Tefferi A, Dunn WF, Litzow MR, Peters SG. Intensive care unit support and Acute Physiology and Chronic Health Evaluation III performance in hematopoietic stem cell transplant recipients. Crit Care Med. 2003;31:1715–21.

    Article  Google Scholar 

  25. Andrykowski MA, Bishop MM, Hahn EA, Cella DF, Beaumont JL, Brady MJ, et al. Long-term health-related quality of life, growth, and spiritual well-being after hematopoietic stem-cell transplantation. J Clin Oncol. 2005;23:599–608.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to express their appreciation for the contributions of all the doctors and nurses at Okayama University Hospital. The authors would like to thank Enago (http://www.enago.jp) for the English language review.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nobuharu Fujii.

Ethics declarations

Conflict of interest

The authors report no potential competing conflicts of interest.

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nakamura, M., Fujii, N., Shimizu, K. et al. Long-term outcomes in patients treated in the intensive care unit after hematopoietic stem cell transplantation. Int J Hematol 108, 622–629 (2018). https://doi.org/10.1007/s12185-018-2536-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12185-018-2536-x

Keywords

  • Intensive care unit
  • Hematopoietic stem cell transplantation
  • Neutropenia
  • Number of prior transplants
  • Long-term outcomes