Survival and prognostic factors of allogeneic hematopoietic stem cell transplant recipients admitted to intensive care unit

Abstract

Th roughout the course of the disease, patients with hematological malignancies can present life-threatening complications, leading to admission to the intensive care unit (ICU). Th e fi rst studies on this population [1] used to discourage ICU admission for patients with hematological malignancies, particularly when invasive mechanical ventilation (MV) was necessary, with up to 85% ICU mortality rate in that setting [2,3]. However, these early studies mixed diff erent populations of patients, particularly patients with and without allogeneic hematopoietic stem cell transplant (HSCT) [4]. During the last 20 years, the survival of patients with hematological malignancies in the ICU has considerably improved, with the mortality rate reduced to 60%, even for patients needing life-sustaining therapy [5 – 7]. Th is improved survival is the consequence of early admission to the ICU, better cooperation between hematologists and intensive care physicians and the progress of both hematology and intensive care medicine along with a better selection of patients requiring ICU admission. However, allogeneic HSCT recipients still have a very poor prognosis in the ICU, because of the duration of severe neutropenia at early post-transplant stages, the use of immunosuppressive drugs and the occurrence of graft-versus-host disease (GVHD) at later stages [8]. Pulmonary complications are particularly frequent and lead to mechanical ventilation in up to 30% of patients [9]. In specialized centers, survival of allogeneic HSCT recipients in ICUs has slightly improved over recent years, even in cases of mechanical ventilation [10], but only a few studies have focused on this specifi c population. In this study, we retrospectively evaluated, over a period of 10 years, short- and long-term survival, organ failures and prognostic factors for this population admitted to our ICU. All consecutive allogeneic HSCT recipients from our department of hematology admitted to the medical ICU