Abstract
The use of allogeneic haematopoietic stem cell transplantation (Allo-HSCT) is a standard treatment option for many patients with haematological malignancies. Historically, patients requiring intensive care unit (ICU) admission for transplant-related toxicities have fared extremely poorly, with high ICU mortality rates. Little is known about the impact of reduced intensity Allo-HSCT conditioning regimens in older patients on the ICU and subsequent long-term outcomes. A retrospective analysis of data collected from 164 consecutive Allo-HSCT recipients admitted to ICU for a total of 213 admissions, at a single centre over an 11·5-year study period was performed. Follow-up was recorded until 31 March 2011. Autologous HSCT recipients were excluded. In this study we report favourable ICU survival following Allo-HSCT and, for the first time, demonstrate significantly better survival for patients who underwent Allo-HSCT with reduced intensity conditioning compared to those treated with myeloablative conditioning regimens. In addition, we identified the need for ventilation (invasive or non-invasive) as an independently significant adverse factor affecting short-term ICU outcome. For patients surviving ICU admission, subsequent long-term overall survival was excellent; 61% and 51% at 1 and 5 years, respectively. Reduced intensity Allo-HSCT patients admitted to ICU with critical illness have improved survival compared to myeloablative Allo-HSCT recipients.
Highlights
A retrospective analysis of data collected from 164 consecutive adult and adolescent Allo-HSCT recipients admitted to the critical care unit for a total of 213 admissions, at a single centre, University College London Hospitals NHS Foundation Trust (UCLH), between June 1996 and December 2007 was performed
The median age of patients at last admission to intensive care unit (ICU) was 41 years and the recipients of reduced intensity (RI) Allo-HSCT were significantly older at 50 years compared to MA Allo-HSCT patients at 39 years, P = 0Á0001
ICU, intensive care unit; OR, odds ratio; 95% CI, 95% confidence interval; UD, unrelated donor; Sib, matched sibling donor; RI, reduced intensity; MA, myeloablative; NIV, non-invasive ventilation; Mechanical ventilation (MV), mechanical ventilation; APACHEII, Acute Physiology and Chronic Health Evaluation Score
Summary
The primary aim of this study was to determine the short and long-term outcomes of patients admitted to the ICU in our institution following Allo-HSCT over an 11Á5-year period
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