Abstract
Patients with bone marrow transplant may present with acute, life-threatening complications which frequently (40% of our cases) require intensive care unit treatment and result in an increased mortality (76% in this series). In an attempt to reach a more objective prognostic assessment, we have analyzed those factors related to the worst outcome in the 25 patients with bone marrow transplant admitted into our intensive care unit. Respiratory failure was the most frequent complication (72%), with an 83% mortality. Graft-versus-host disease and neutropenia led to a greater number of infectious complications with a poor outcome. Failure of more than three organ systems, septic shock and mechanical ventilation were statistically associated with mortality (p<0.05), and all patients who required mechanical ventilation for more than seven days or needed intensive therapy for more than 10 days died. The presence of septic shock, multisystem failure and severe neutropenia on admission should be considered as initial indicators of a poor prognosis. More than 7 days of mechanical ventilation and an intensive care unit stay of more than 10 days could be critical points in the reassessment of the intensity and prolongation of treatment.
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References
Beschorner WE, Pino J, Boitnott JK, Tutschka PJ, Santos WG (1980) Pathology of the liver with bone marrow transplantation. Am J Pathol 99:369
Blume KG, Beutler E, Bross KI, Chillar RK, Ellington OB, Fahey JL, Farbstein MJ, Forman SJ, Schmidt GM, Scott EP, Spruce WE, Turner MA, Wolf JL (1980) Bone-Marrow ablation and allogeneic transplantation in acute leukemia. N Engl J Med 302:1041
Bowden AR, Meyers JD (1985) Infectious complications following marrow transplantation. Plasma Ther Transfus Technol 6:285
Champlin RE, Gale RP (1984) The early complications of bone marrow transplantation. Semin Hematol 21:101
Deeg J, Storb R, Thomas ED (1984) Bone marrow transplantation. A review of delayed complications. Br J Haematol 57:185
Dominguez de Villota V, Algora A, Rubio JJ, Mosquera JM, Galdos P, Diez-Balda V (1981) Septicaemia in a medical intensive care unit. Clinical, biochemical and microbiological data of 109 cases. Intensive Care Med 9:109
Estopa R, Torres A, Kastanos N, Rives A, Agusti-Vidal A, Rozman C (1984) Acute respiratory failure in severe haematologic disorders. Crit Care Med 12:26
Goldman JM, Apperly JF, Jones L, Marcus R, Goolden AWG, Batchelor R, Hale G, Waldmann H, Reid CD, Hows J, Gordon Smith E, Catovsky D, Galton DAG (1986) Bone marrow transplantation for patients with chronic myeloid leukemia. N Engl J Med 314:202
Goldman JM, Baughan ASJ, McCarthy DM, Worsely AM, Hows JM, Gordon-Smith EC, Catovsky D, Batchelor JR, Goolden AWG, Galton DAG (1983) Transplante medular en pacientes con LMC en fase crónica. Lancet 13
Graze PR, Gale RP (1979) Enfermedad crónica inducida por el injerto contra huesped. Un síndrome de origen inmunitario. Am J Med 66:611
Kadota RP, Smithson WA (1982) Bone marrow transplantation for diseases of childhood. Mayo Clin Proc 57:668
Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE (1981) APACHE. Acute physiological and chronic health evaluation, a physiologically based classification system. Crit Care Med 9:591
Krowka MJ, Rosenow EC, Hoagland HC (1985) Pulmonary complications of bone marrow transplantation. Chest 87:237
Lloyd-Thomas AR, Dhalinal HS, Lister TA, Hinds CJ (1986) Intensive therapy for life-threatening complications of haematological malignancy. Intensive Care Med 12:317
Rozman C (1983) Trasplante de médula osea. Med Int 1:85
Schuster DP, Marion JM (1983) Precedents for a meaningful recovery during treatment in a medical intensive care unit. Am J Med 75:402
Storb R, Deeg JH, Whitehead J, Appelbaum F, Beatty P, Bensinger W, Buckner D, Clift R, Doney K, Farewell V, Hansen J, Hill R, Lum L, Martin P, McGuffin R, Sanders J, Stewart P, Sullivan K, Witherspoon R, Yee G, Thomas ED (1986) Methotrexate and cyclosporine alone for prophylaxis of acute graft versus host disease after marrow transplantation for leukemia. N Engl J Med 314:729
Storb R, Prentice RL, Buckner CD, Clift RA, Appelbaum F, Deeg J, Doney K, Hansen JA, Mason M, Sanders JE, Singer J, Sullivan KM, Witherspoon RP, Thomas ED (1983) Graft-versus-host disease and survival in patients with aplastic anemia treated by marrow grafts from HLA-identical siblings. N Engl J Med 308:302
Storb R, Santos GW (1983) Application of bone marrow transplantation in leukaemia and aplastic anemia. Clin Haematol 12:721
Sullivan KM, Deeg J, Sanders JE, Shulman HM, Witherspoon RP, Doney K, Appelbaum FR, Schubert MM, Stewart P, Springmeyer S, McDonald GB, Storb R, Thomas ED (1984) Late complications after marrow transplantation. Semin Hematol 21:53
Thomas ED, Storb R, Clift RA, Fefer A, Johnson FL, Neiman PE, Lerner KG, Glucksberg H, Buckner CD (1975) Bone marrow transplantation. N Engl J Med 292:832, 895
Winston JD, Gale RP, Meyer DV, Young LS and the UCLA Bone Marrow Transplantation Group (1979) Infectious complications of human bone marrow transplantation. Medicine (Baltimore) 58:1
Zwaan FE, Hermans J, Barret AJ, Speck B (1984) Bone marrow transplantation for acute nonlymphoblastic leukaemia: a survey of the European Group for Bone Marrow Transplantation (EGBMT). Br J Haematol 56:645
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Torrecilla, C., Cortés, J.L., Chamorro, C. et al. Prognostic assessment of the acute complications of bone marrow transplantation requiring intensive therapy. Intensive Care Med 14, 393–398 (1988). https://doi.org/10.1007/BF00262895
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DOI: https://doi.org/10.1007/BF00262895