TY - JOUR
T1 - Outcome of critically ill allogeneic hematopoietic stem-cell transplantation recipients
T2 - A reappraisal of indications for organ failure supports
AU - Pène, Frédéric
AU - Aubron, Cécile
AU - Azoulay, Elie
AU - Blot, François
AU - Thiéry, Guillaume
AU - Raynard, Bruno
AU - Schlemmer, Benoît
AU - Nitenberg, Gêrard
AU - Buzyn, Agnés
AU - Arnaud, Philippe
AU - Socié, Gérard
AU - Mira, Jean Paul
PY - 2006/2/1
Y1 - 2006/2/1
N2 - Purpose: Because the overall outcome of critically ill hematologic patients has improved, we evaluated the short-term and long-term outcomes of the poor risk subgroup of allogeneic hematopoietic stem-cell transplantation (HSCT) recipients requiring admission to the intensive care unit (ICU). Patients and Methods: This was a retrospective multicenter study of allogeneic HSCT recipients admitted to the ICU between 1997 and 2003. Results: Two hundred nine critically ill allogeneic HSCT recipients were included in the study. Admission in the ICU occurred during the engraftment period (≤ 30 days after transplantation) for 70 of the patients and after the engraftment period for 139 patients. The overall in-ICU, in-hospital, 6-month, and 1-year survival rates were 48.3%, 32.5%, 27.2%, and 21%, respectively. Mechanical ventilation was required in 122 patients and led to a dramatic decrease in survival rates, resulting in in-ICU, in-hospital, 6-month, and 1-year survival rates of 18%, 15.6%, 14%, and 10.6%, respectively. Mechanical ventilation, elevated bilirubin level, and corticosteroid treatment for the indication of active graft-versus-host disease (GVHD) were independent predictors of death in the whole cohort. In the subgroup of patients requiring mechanical ventilation, associated organ failures, such as shock and liver dysfunction, were independent predictors of death. ICU admission during engraftment period was associated with acceptable outcome in mechanically ventilated patients, whereas patients with late complications of HSCT in the setting of active GVHD had a poor outcome. Conclusion: Extensive unlimited intensive care support is justified for allogeneic HSCT recipients with complications occurring during the engraftment period. Conversely, initiation or maintenance of mechanical ventilation is questionable in the setting of active GVHD.
AB - Purpose: Because the overall outcome of critically ill hematologic patients has improved, we evaluated the short-term and long-term outcomes of the poor risk subgroup of allogeneic hematopoietic stem-cell transplantation (HSCT) recipients requiring admission to the intensive care unit (ICU). Patients and Methods: This was a retrospective multicenter study of allogeneic HSCT recipients admitted to the ICU between 1997 and 2003. Results: Two hundred nine critically ill allogeneic HSCT recipients were included in the study. Admission in the ICU occurred during the engraftment period (≤ 30 days after transplantation) for 70 of the patients and after the engraftment period for 139 patients. The overall in-ICU, in-hospital, 6-month, and 1-year survival rates were 48.3%, 32.5%, 27.2%, and 21%, respectively. Mechanical ventilation was required in 122 patients and led to a dramatic decrease in survival rates, resulting in in-ICU, in-hospital, 6-month, and 1-year survival rates of 18%, 15.6%, 14%, and 10.6%, respectively. Mechanical ventilation, elevated bilirubin level, and corticosteroid treatment for the indication of active graft-versus-host disease (GVHD) were independent predictors of death in the whole cohort. In the subgroup of patients requiring mechanical ventilation, associated organ failures, such as shock and liver dysfunction, were independent predictors of death. ICU admission during engraftment period was associated with acceptable outcome in mechanically ventilated patients, whereas patients with late complications of HSCT in the setting of active GVHD had a poor outcome. Conclusion: Extensive unlimited intensive care support is justified for allogeneic HSCT recipients with complications occurring during the engraftment period. Conversely, initiation or maintenance of mechanical ventilation is questionable in the setting of active GVHD.
UR - http://www.scopus.com/inward/record.url?scp=33644845172&partnerID=8YFLogxK
U2 - 10.1200/JCO.2005.03.9073
DO - 10.1200/JCO.2005.03.9073
M3 - Article
C2 - 16380411
AN - SCOPUS:33644845172
SN - 0732-183X
VL - 24
SP - 643
EP - 649
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 4
ER -