Allogeneic hematopoietic stem cell transplantation after reduced intensity conditioning regimen: Outcomes of patients admitted to intensive care unit
Abstract Purpose The prognosis of allogeneic hematopoietic stem cell transplantation (HSCT) patients admitted to the intensive care unit (ICU) is still poor. Overall, when these patients receive reduced intensity conditioning (RIC) regimens, the survival is better. To date, no study has specifically...
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| creator | Mokart, Djamel, MD Granata, Angela, MD Crocchiolo, Roberto, MD Sannini, Antoine, MD Chow-Chine, Laurent, MD Brun, Jean-Paul, MD Bisbal, Magali, MD Faucher, Marion, MD, PhD Faucher, Catherine, MD Blache, Jean-Louis, MD Castagna, Luca, MD Fürst, Sabine, MD Blaise, Didier, MD |
| description | Abstract Purpose The prognosis of allogeneic hematopoietic stem cell transplantation (HSCT) patients admitted to the intensive care unit (ICU) is still poor. Overall, when these patients receive reduced intensity conditioning (RIC) regimens, the survival is better. To date, no study has specifically evaluated the outcome of RIC allogeneic HSCT admitted to the ICU. Methods We realized a retrospective study of 102 patients admitted to the ICU among a cohort of 601 consecutive patients receiving RIC regimens. The primary objective of the study was to assess in-ICU and inhospital mortality rates. Results The ICU mortality was 39.2%, and the hospital mortality was 59.8%. The median overall survival of ICU patients was 8.2 months (95% confidence interval [CI], 5.7-10.6) vs 75 (95% CI, 63-87) in non-ICU patients ( P < .0001). During hospital stay, an ICU admission for neurologic dysfunction was independently associated with hospital survival ( P = .012). The use of invasive mechanical ventilation (IMV; P = .011), Simplified Acute Physiology Score II ( P = .003), and longer time between diagnosis of malignancy and HSCT ( P = .012) were associated with hospital mortality. The overall survival of the ICU survivors was significantly lower than that of non-ICU patients (hazard ratio, 3.61 [95% CI, 2.18-4.59]; P < .001). The median survival of ICU survivors was 9 months (95% CI, 4-14) vs 75 (95% CI, 63-87) in non-ICU patients ( P < .0001). Noninvasive ventilation (NIV) was successful (not followed by IMV in 61% of cases [25/41 NIV patients]), and failure of NIV was not associated with hospital mortality in patients treated with subsequent IMV. Conclusion From our study, short-term survival rates of ICU patients receiving RIC regimens justify a broad ICU admission policy. The use of IMV is associated with hospital mortality, whereas the use of NIV is frequently successful. Long-term outcome remains poor after ICU discharge. |
| doi_str_mv | 10.1016/j.jcrc.2015.06.020 |
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Overall, when these patients receive reduced intensity conditioning (RIC) regimens, the survival is better. To date, no study has specifically evaluated the outcome of RIC allogeneic HSCT admitted to the ICU. Methods We realized a retrospective study of 102 patients admitted to the ICU among a cohort of 601 consecutive patients receiving RIC regimens. The primary objective of the study was to assess in-ICU and inhospital mortality rates. Results The ICU mortality was 39.2%, and the hospital mortality was 59.8%. The median overall survival of ICU patients was 8.2 months (95% confidence interval [CI], 5.7-10.6) vs 75 (95% CI, 63-87) in non-ICU patients ( P < .0001). During hospital stay, an ICU admission for neurologic dysfunction was independently associated with hospital survival ( P = .012). The use of invasive mechanical ventilation (IMV; P = .011), Simplified Acute Physiology Score II ( P = .003), and longer time between diagnosis of malignancy and HSCT ( P = .012) were associated with hospital mortality. The overall survival of the ICU survivors was significantly lower than that of non-ICU patients (hazard ratio, 3.61 [95% CI, 2.18-4.59]; P < .001). The median survival of ICU survivors was 9 months (95% CI, 4-14) vs 75 (95% CI, 63-87) in non-ICU patients ( P < .0001). Noninvasive ventilation (NIV) was successful (not followed by IMV in 61% of cases [25/41 NIV patients]), and failure of NIV was not associated with hospital mortality in patients treated with subsequent IMV. Conclusion From our study, short-term survival rates of ICU patients receiving RIC regimens justify a broad ICU admission policy. The use of IMV is associated with hospital mortality, whereas the use of NIV is frequently successful. Long-term outcome remains poor after ICU discharge.</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2015.06.020</identifier><identifier>PMID: 26193780</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Allogeneic hematopoietic stem cell transplantation ; Bone marrow ; Critical Care ; Critical Care - statistics & numerical data ; Female ; Hematology patients ; Hematopoietic Stem Cell Transplantation - methods ; Hematopoietic Stem Cell Transplantation - mortality ; Hospital Mortality ; Hospitalization ; Humans ; Intensive care unit ; Intensive Care Units - statistics & numerical data ; Length of Stay - statistics & numerical data ; Male ; Mechanical ventilation ; Middle Aged ; Mortality ; Noninvasive Ventilation - methods ; Noninvasive Ventilation - mortality ; Patients ; Prognosis ; Reduced-intensity conditioning regimen ; Retrospective Studies ; Survival Rate ; Transplantation Conditioning - methods ; Transplantation Conditioning - mortality ; Transplantation, Autologous - methods ; Transplantation, Autologous - mortality ; Transplants & implants</subject><ispartof>Journal of critical care, 2015-10, Vol.30 (5), p.1107-1113</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Oct 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c509t-6c88fffca89e3f829075f9ad90038f1e0d2f231103e6d10df2507bd12a122cd23</citedby><cites>FETCH-LOGICAL-c509t-6c88fffca89e3f829075f9ad90038f1e0d2f231103e6d10df2507bd12a122cd23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1708009701?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000,64390,64392,64394,72474</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26193780$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mokart, Djamel, MD</creatorcontrib><creatorcontrib>Granata, Angela, MD</creatorcontrib><creatorcontrib>Crocchiolo, Roberto, MD</creatorcontrib><creatorcontrib>Sannini, Antoine, MD</creatorcontrib><creatorcontrib>Chow-Chine, Laurent, MD</creatorcontrib><creatorcontrib>Brun, Jean-Paul, MD</creatorcontrib><creatorcontrib>Bisbal, Magali, MD</creatorcontrib><creatorcontrib>Faucher, Marion, MD, PhD</creatorcontrib><creatorcontrib>Faucher, Catherine, MD</creatorcontrib><creatorcontrib>Blache, Jean-Louis, MD</creatorcontrib><creatorcontrib>Castagna, Luca, MD</creatorcontrib><creatorcontrib>Fürst, Sabine, MD</creatorcontrib><creatorcontrib>Blaise, Didier, MD</creatorcontrib><title>Allogeneic hematopoietic stem cell transplantation after reduced intensity conditioning regimen: Outcomes of patients admitted to intensive care unit</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>Abstract Purpose The prognosis of allogeneic hematopoietic stem cell transplantation (HSCT) patients admitted to the intensive care unit (ICU) is still poor. Overall, when these patients receive reduced intensity conditioning (RIC) regimens, the survival is better. To date, no study has specifically evaluated the outcome of RIC allogeneic HSCT admitted to the ICU. Methods We realized a retrospective study of 102 patients admitted to the ICU among a cohort of 601 consecutive patients receiving RIC regimens. The primary objective of the study was to assess in-ICU and inhospital mortality rates. Results The ICU mortality was 39.2%, and the hospital mortality was 59.8%. The median overall survival of ICU patients was 8.2 months (95% confidence interval [CI], 5.7-10.6) vs 75 (95% CI, 63-87) in non-ICU patients ( P < .0001). During hospital stay, an ICU admission for neurologic dysfunction was independently associated with hospital survival ( P = .012). The use of invasive mechanical ventilation (IMV; P = .011), Simplified Acute Physiology Score II ( P = .003), and longer time between diagnosis of malignancy and HSCT ( P = .012) were associated with hospital mortality. The overall survival of the ICU survivors was significantly lower than that of non-ICU patients (hazard ratio, 3.61 [95% CI, 2.18-4.59]; P < .001). The median survival of ICU survivors was 9 months (95% CI, 4-14) vs 75 (95% CI, 63-87) in non-ICU patients ( P < .0001). Noninvasive ventilation (NIV) was successful (not followed by IMV in 61% of cases [25/41 NIV patients]), and failure of NIV was not associated with hospital mortality in patients treated with subsequent IMV. Conclusion From our study, short-term survival rates of ICU patients receiving RIC regimens justify a broad ICU admission policy. The use of IMV is associated with hospital mortality, whereas the use of NIV is frequently successful. Long-term outcome remains poor after ICU discharge.</description><subject>Adult</subject><subject>Allogeneic hematopoietic stem cell transplantation</subject><subject>Bone marrow</subject><subject>Critical Care</subject><subject>Critical Care - statistics & numerical data</subject><subject>Female</subject><subject>Hematology patients</subject><subject>Hematopoietic Stem Cell Transplantation - methods</subject><subject>Hematopoietic Stem Cell Transplantation - mortality</subject><subject>Hospital Mortality</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Intensive care unit</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Mechanical ventilation</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Noninvasive Ventilation - methods</subject><subject>Noninvasive Ventilation - mortality</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Reduced-intensity conditioning regimen</subject><subject>Retrospective Studies</subject><subject>Survival Rate</subject><subject>Transplantation Conditioning - methods</subject><subject>Transplantation Conditioning - mortality</subject><subject>Transplantation, Autologous - methods</subject><subject>Transplantation, Autologous - mortality</subject><subject>Transplants & implants</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kkFrFTEUhQdR7Gv1D7iQgBs3M94kb2YyIoVSrAqFLtR1SJObZ8aZ5JlkCu-H-H_N8FqFLlyFkO8ccs-5VfWKQkOBdu_GZtRRNwxo20DXAIMn1Ya2bV-LjrZPqw0Iwethu6Un1WlKIwDtOW-fVyesowPvBWyq3xfTFHbo0WnyA2eVwz44zOWWMs5E4zSRHJVP-0n5rLILniibMZKIZtFoiPMZfXL5QHTwxq2E87vyvHMz-vfkZsk6zJhIsGRfDNDnRJSZXc5FncODwR0SrSKSxbv8onpm1ZTw5f15Vn2_-vjt8nN9ffPpy-XFda1bGHLdaSGstVqJAbkVbIC-tYMyAwAXliIYZhmnFDh2hoKxrIX-1lCmKGPaMH5WvT367mP4tWDKcnZpnVl5DEuStO-Z4IxutwV98wgdwxJ9-V2hQAAMPdBCsSOlY0gpopX76GYVD5KCXEuTo1xLk2tpEjpZSiui1_fWy-2M5q_koaUCfDgCWLK4cxhl0iXHkr6LqLM0wf3f__yRXE_OO62mn3jA9G8OmZgE-XVdm3VraFty7FjP_wBiQcBP</recordid><startdate>20151001</startdate><enddate>20151001</enddate><creator>Mokart, Djamel, MD</creator><creator>Granata, Angela, MD</creator><creator>Crocchiolo, Roberto, MD</creator><creator>Sannini, Antoine, MD</creator><creator>Chow-Chine, Laurent, MD</creator><creator>Brun, Jean-Paul, MD</creator><creator>Bisbal, Magali, MD</creator><creator>Faucher, Marion, MD, PhD</creator><creator>Faucher, Catherine, MD</creator><creator>Blache, Jean-Louis, MD</creator><creator>Castagna, Luca, MD</creator><creator>Fürst, Sabine, MD</creator><creator>Blaise, Didier, MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20151001</creationdate><title>Allogeneic hematopoietic stem cell transplantation after reduced intensity conditioning regimen: Outcomes of patients admitted to intensive care unit</title><author>Mokart, Djamel, MD ; Granata, Angela, MD ; Crocchiolo, Roberto, MD ; Sannini, Antoine, MD ; Chow-Chine, Laurent, MD ; Brun, Jean-Paul, MD ; Bisbal, Magali, MD ; Faucher, Marion, MD, PhD ; Faucher, Catherine, MD ; Blache, Jean-Louis, MD ; Castagna, Luca, MD ; Fürst, Sabine, MD ; Blaise, Didier, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c509t-6c88fffca89e3f829075f9ad90038f1e0d2f231103e6d10df2507bd12a122cd23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Allogeneic hematopoietic stem cell transplantation</topic><topic>Bone marrow</topic><topic>Critical Care</topic><topic>Critical Care - statistics & numerical data</topic><topic>Female</topic><topic>Hematology patients</topic><topic>Hematopoietic Stem Cell Transplantation - methods</topic><topic>Hematopoietic Stem Cell Transplantation - mortality</topic><topic>Hospital Mortality</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Intensive care unit</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Mechanical ventilation</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Noninvasive Ventilation - methods</topic><topic>Noninvasive Ventilation - mortality</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Reduced-intensity conditioning regimen</topic><topic>Retrospective Studies</topic><topic>Survival Rate</topic><topic>Transplantation Conditioning - methods</topic><topic>Transplantation Conditioning - mortality</topic><topic>Transplantation, Autologous - methods</topic><topic>Transplantation, Autologous - mortality</topic><topic>Transplants & implants</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mokart, Djamel, MD</creatorcontrib><creatorcontrib>Granata, Angela, MD</creatorcontrib><creatorcontrib>Crocchiolo, Roberto, MD</creatorcontrib><creatorcontrib>Sannini, Antoine, MD</creatorcontrib><creatorcontrib>Chow-Chine, Laurent, MD</creatorcontrib><creatorcontrib>Brun, Jean-Paul, MD</creatorcontrib><creatorcontrib>Bisbal, Magali, MD</creatorcontrib><creatorcontrib>Faucher, Marion, MD, PhD</creatorcontrib><creatorcontrib>Faucher, Catherine, MD</creatorcontrib><creatorcontrib>Blache, Jean-Louis, MD</creatorcontrib><creatorcontrib>Castagna, Luca, MD</creatorcontrib><creatorcontrib>Fürst, Sabine, MD</creatorcontrib><creatorcontrib>Blaise, Didier, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mokart, Djamel, MD</au><au>Granata, Angela, MD</au><au>Crocchiolo, Roberto, MD</au><au>Sannini, Antoine, MD</au><au>Chow-Chine, Laurent, MD</au><au>Brun, Jean-Paul, MD</au><au>Bisbal, Magali, MD</au><au>Faucher, Marion, MD, PhD</au><au>Faucher, Catherine, MD</au><au>Blache, Jean-Louis, MD</au><au>Castagna, Luca, MD</au><au>Fürst, Sabine, MD</au><au>Blaise, Didier, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Allogeneic hematopoietic stem cell transplantation after reduced intensity conditioning regimen: Outcomes of patients admitted to intensive care unit</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2015-10-01</date><risdate>2015</risdate><volume>30</volume><issue>5</issue><spage>1107</spage><epage>1113</epage><pages>1107-1113</pages><issn>0883-9441</issn><eissn>1557-8615</eissn><abstract>Abstract Purpose The prognosis of allogeneic hematopoietic stem cell transplantation (HSCT) patients admitted to the intensive care unit (ICU) is still poor. Overall, when these patients receive reduced intensity conditioning (RIC) regimens, the survival is better. To date, no study has specifically evaluated the outcome of RIC allogeneic HSCT admitted to the ICU. Methods We realized a retrospective study of 102 patients admitted to the ICU among a cohort of 601 consecutive patients receiving RIC regimens. The primary objective of the study was to assess in-ICU and inhospital mortality rates. Results The ICU mortality was 39.2%, and the hospital mortality was 59.8%. The median overall survival of ICU patients was 8.2 months (95% confidence interval [CI], 5.7-10.6) vs 75 (95% CI, 63-87) in non-ICU patients ( P < .0001). During hospital stay, an ICU admission for neurologic dysfunction was independently associated with hospital survival ( P = .012). The use of invasive mechanical ventilation (IMV; P = .011), Simplified Acute Physiology Score II ( P = .003), and longer time between diagnosis of malignancy and HSCT ( P = .012) were associated with hospital mortality. The overall survival of the ICU survivors was significantly lower than that of non-ICU patients (hazard ratio, 3.61 [95% CI, 2.18-4.59]; P < .001). The median survival of ICU survivors was 9 months (95% CI, 4-14) vs 75 (95% CI, 63-87) in non-ICU patients ( P < .0001). Noninvasive ventilation (NIV) was successful (not followed by IMV in 61% of cases [25/41 NIV patients]), and failure of NIV was not associated with hospital mortality in patients treated with subsequent IMV. Conclusion From our study, short-term survival rates of ICU patients receiving RIC regimens justify a broad ICU admission policy. The use of IMV is associated with hospital mortality, whereas the use of NIV is frequently successful. Long-term outcome remains poor after ICU discharge.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26193780</pmid><doi>10.1016/j.jcrc.2015.06.020</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Allogeneic hematopoietic stem cell transplantation Bone marrow Critical Care Critical Care - statistics & numerical data Female Hematology patients Hematopoietic Stem Cell Transplantation - methods Hematopoietic Stem Cell Transplantation - mortality Hospital Mortality Hospitalization Humans Intensive care unit Intensive Care Units - statistics & numerical data Length of Stay - statistics & numerical data Male Mechanical ventilation Middle Aged Mortality Noninvasive Ventilation - methods Noninvasive Ventilation - mortality Patients Prognosis Reduced-intensity conditioning regimen Retrospective Studies Survival Rate Transplantation Conditioning - methods Transplantation Conditioning - mortality Transplantation, Autologous - methods Transplantation, Autologous - mortality Transplants & implants |
| title | Allogeneic hematopoietic stem cell transplantation after reduced intensity conditioning regimen: Outcomes of patients admitted to intensive care unit |
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