Outcome of allogeneic hematopoietic stem cell transplant recipients admitted to the intensive care unit with a focus on haploidentical graft and sequential conditioning regimen: results of a retrospective study
Haploidentical transplantation has extended the availability of allogeneic hematopoietic stem cell transplant (alloHCT) to almost all patients. Sequential conditioning regimens have been proposed for the treatment of hematological active disease. Whether these new transplantation procedures affect t...
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creator | Gournay, Viviane Dumas, Guillaume Lavillegrand, Jean-Rémi Hariri, Geoffroy Urbina, Tomas Baudel, Jean-Luc Ait-Oufella, Hafid Maury, Eric Brissot, Eolia Legrand, Ollivier Malard, Florent Mohty, Mohamad Guidet, Bertrand Duléry, Rémy Bigé, Naïke |
description | Haploidentical transplantation has extended the availability of allogeneic hematopoietic stem cell transplant (alloHCT) to almost all patients. Sequential conditioning regimens have been proposed for the treatment of hematological active disease. Whether these new transplantation procedures affect the prognosis of critically ill alloHCT recipients remains unknown. We evaluated this question in a retrospective study including consecutive alloHCT patients admitted to the intensive care unit of a tertiary academic center from 2010 to 2017. During the study period, 412 alloHCTs were performed and 110 (27%) patients—median age 55 (36–64) years—were admitted to ICU in a median time of 58.5 (14–245) days after alloHCT. Twenty-nine (26%) patients had received a haploidentical graft and 34 (31%) a sequential conditioning. Median SOFA score was 9 (6–11). Invasive mechanical ventilation (MV) was required in 61 (55%) patients. Fifty-six (51%) patients died in the hospital. Independent factors associated with in-hospital mortality were as follows: MV (OR=8.44 [95% CI 3.30–23.19],
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p
<0.001), delta SOFA between day 3 and day 1 (OR=1.60 [95% CI 1.31–2.05],
p
<0.0001), and sequential conditioning (OR=3.7 [95% CI 1.14–12.92],
p
=0.033). Sequential conditioning was also independently associated with decreased overall survival (HR=1.86 [95% CI 1.05–3.31],
p
=0.03). Other independent factors associated with reduced overall survival were HCT-specific comorbidity index ≥2 (HR=1.76 [95% CI 1.10–2.84],
p
=0.02), acute GVHD grade ≥2 (HR=1.88 [95% CI 1.14–3.10],
p
=0.01), MV (HR=2.37 [95% CI 1.38–4.07,
p
=0.002), and vasopressors (HR=2.21 [95% CI 1.38–3.54],
p
=0.001). Haploidentical transplantation did not affect outcome. Larger multicenter studies are warranted to confirm these results.</description><identifier>ISSN: 0939-5555</identifier><identifier>EISSN: 1432-0584</identifier><identifier>DOI: 10.1007/s00277-021-04640-7</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Hematology ; Intensive care ; Life Sciences ; Medical prognosis ; Medicine ; Medicine & Public Health ; Oncology ; Original Article ; Stem cell transplantation</subject><ispartof>Annals of Hematology, 2021-11, Vol.100 (11), p.2787-2797</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021</rights><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c386t-58b2ed1f8f6730f52910bbf1515d9dea0b026e6c0050981a365cc9725b6720b43</citedby><cites>FETCH-LOGICAL-c386t-58b2ed1f8f6730f52910bbf1515d9dea0b026e6c0050981a365cc9725b6720b43</cites><orcidid>0000-0002-2945-6293 ; 0000-0003-4471-418X ; 0000-0002-7643-6770 ; 0000-0002-2253-1844</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00277-021-04640-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00277-021-04640-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,776,780,881,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://hal.sorbonne-universite.fr/hal-03888132$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Gournay, Viviane</creatorcontrib><creatorcontrib>Dumas, Guillaume</creatorcontrib><creatorcontrib>Lavillegrand, Jean-Rémi</creatorcontrib><creatorcontrib>Hariri, Geoffroy</creatorcontrib><creatorcontrib>Urbina, Tomas</creatorcontrib><creatorcontrib>Baudel, Jean-Luc</creatorcontrib><creatorcontrib>Ait-Oufella, Hafid</creatorcontrib><creatorcontrib>Maury, Eric</creatorcontrib><creatorcontrib>Brissot, Eolia</creatorcontrib><creatorcontrib>Legrand, Ollivier</creatorcontrib><creatorcontrib>Malard, Florent</creatorcontrib><creatorcontrib>Mohty, Mohamad</creatorcontrib><creatorcontrib>Guidet, Bertrand</creatorcontrib><creatorcontrib>Duléry, Rémy</creatorcontrib><creatorcontrib>Bigé, Naïke</creatorcontrib><title>Outcome of allogeneic hematopoietic stem cell transplant recipients admitted to the intensive care unit with a focus on haploidentical graft and sequential conditioning regimen: results of a retrospective study</title><title>Annals of Hematology</title><addtitle>Ann Hematol</addtitle><description>Haploidentical transplantation has extended the availability of allogeneic hematopoietic stem cell transplant (alloHCT) to almost all patients. Sequential conditioning regimens have been proposed for the treatment of hematological active disease. Whether these new transplantation procedures affect the prognosis of critically ill alloHCT recipients remains unknown. We evaluated this question in a retrospective study including consecutive alloHCT patients admitted to the intensive care unit of a tertiary academic center from 2010 to 2017. During the study period, 412 alloHCTs were performed and 110 (27%) patients—median age 55 (36–64) years—were admitted to ICU in a median time of 58.5 (14–245) days after alloHCT. Twenty-nine (26%) patients had received a haploidentical graft and 34 (31%) a sequential conditioning. Median SOFA score was 9 (6–11). Invasive mechanical ventilation (MV) was required in 61 (55%) patients. Fifty-six (51%) patients died in the hospital. Independent factors associated with in-hospital mortality were as follows: MV (OR=8.44 [95% CI 3.30–23.19],
p
<0.001), delta SOFA between day 3 and day 1 (OR=1.60 [95% CI 1.31–2.05],
p
<0.0001), and sequential conditioning (OR=3.7 [95% CI 1.14–12.92],
p
=0.033). Sequential conditioning was also independently associated with decreased overall survival (HR=1.86 [95% CI 1.05–3.31],
p
=0.03). Other independent factors associated with reduced overall survival were HCT-specific comorbidity index ≥2 (HR=1.76 [95% CI 1.10–2.84],
p
=0.02), acute GVHD grade ≥2 (HR=1.88 [95% CI 1.14–3.10],
p
=0.01), MV (HR=2.37 [95% CI 1.38–4.07,
p
=0.002), and vasopressors (HR=2.21 [95% CI 1.38–3.54],
p
=0.001). Haploidentical transplantation did not affect outcome. Larger multicenter studies are warranted to confirm these results.</description><subject>Hematology</subject><subject>Intensive care</subject><subject>Life Sciences</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Stem cell transplantation</subject><issn>0939-5555</issn><issn>1432-0584</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kstu1TAQhiMEEofCC7CyxAYWgbGdi8OuqoBWOlI3sLYcZ3KOq8QO9qSor8kT4RAEEot6Y8_o--di_UXxmsN7DtB-SACibUsQvISqqaBsnxQHXklRQq2qp8UBOtmVdT7Pixcp3QFwoSpxKH7ermTDjCyMzExTOKFHZ9kZZ0NhCQ4pR4lwZhaniVE0Pi2T8cQiWrc49JSYGWZHhAOjwOiMzHlCn9w9MmsistU7Yj8cnZlhY7BrYsGzs1mm4Iasd9ZM7BTNSMz4gSX8vm7ZnLTBD45c8M6fcr-Tm9F_zI-0TrnrNnEOKIa0oKWtXaJ1eHhZPBvNlPDVn_ui-Pb509er6_J4--Xm6vJYWqkaKmvVCxz4qMamlTDWouPQ9yOveT10AxroQTTYWIAaOsWNbGpru1bUfdMK6Ct5Ubzb657NpJfoZhMfdDBOX18e9ZYDqZTiUtzzzL7d2SWGvF4iPbu0_ajxGNakRd10spWd2Mq--Q-9C2v0eZNMKc6habjKlNgpm9dPEce_E3DQmyX0bgmdLaF_W0K3WSR3UcqwP2H8V_oR1S8HJr3e</recordid><startdate>20211101</startdate><enddate>20211101</enddate><creator>Gournay, Viviane</creator><creator>Dumas, Guillaume</creator><creator>Lavillegrand, Jean-Rémi</creator><creator>Hariri, Geoffroy</creator><creator>Urbina, Tomas</creator><creator>Baudel, Jean-Luc</creator><creator>Ait-Oufella, Hafid</creator><creator>Maury, Eric</creator><creator>Brissot, Eolia</creator><creator>Legrand, Ollivier</creator><creator>Malard, Florent</creator><creator>Mohty, Mohamad</creator><creator>Guidet, Bertrand</creator><creator>Duléry, Rémy</creator><creator>Bigé, Naïke</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>1XC</scope><scope>VOOES</scope><orcidid>https://orcid.org/0000-0002-2945-6293</orcidid><orcidid>https://orcid.org/0000-0003-4471-418X</orcidid><orcidid>https://orcid.org/0000-0002-7643-6770</orcidid><orcidid>https://orcid.org/0000-0002-2253-1844</orcidid></search><sort><creationdate>20211101</creationdate><title>Outcome of allogeneic hematopoietic stem cell transplant recipients admitted to the intensive care unit with a focus on haploidentical graft and sequential conditioning regimen: results of a retrospective study</title><author>Gournay, Viviane ; Dumas, Guillaume ; Lavillegrand, Jean-Rémi ; Hariri, Geoffroy ; Urbina, Tomas ; Baudel, Jean-Luc ; Ait-Oufella, Hafid ; Maury, Eric ; Brissot, Eolia ; Legrand, Ollivier ; Malard, Florent ; Mohty, Mohamad ; Guidet, Bertrand ; Duléry, Rémy ; Bigé, Naïke</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c386t-58b2ed1f8f6730f52910bbf1515d9dea0b026e6c0050981a365cc9725b6720b43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Hematology</topic><topic>Intensive care</topic><topic>Life Sciences</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Stem cell transplantation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gournay, Viviane</creatorcontrib><creatorcontrib>Dumas, Guillaume</creatorcontrib><creatorcontrib>Lavillegrand, Jean-Rémi</creatorcontrib><creatorcontrib>Hariri, Geoffroy</creatorcontrib><creatorcontrib>Urbina, Tomas</creatorcontrib><creatorcontrib>Baudel, Jean-Luc</creatorcontrib><creatorcontrib>Ait-Oufella, Hafid</creatorcontrib><creatorcontrib>Maury, Eric</creatorcontrib><creatorcontrib>Brissot, Eolia</creatorcontrib><creatorcontrib>Legrand, Ollivier</creatorcontrib><creatorcontrib>Malard, Florent</creatorcontrib><creatorcontrib>Mohty, Mohamad</creatorcontrib><creatorcontrib>Guidet, Bertrand</creatorcontrib><creatorcontrib>Duléry, Rémy</creatorcontrib><creatorcontrib>Bigé, Naïke</creatorcontrib><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>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</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>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>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><jtitle>Annals of Hematology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gournay, Viviane</au><au>Dumas, Guillaume</au><au>Lavillegrand, Jean-Rémi</au><au>Hariri, Geoffroy</au><au>Urbina, Tomas</au><au>Baudel, Jean-Luc</au><au>Ait-Oufella, Hafid</au><au>Maury, Eric</au><au>Brissot, Eolia</au><au>Legrand, Ollivier</au><au>Malard, Florent</au><au>Mohty, Mohamad</au><au>Guidet, Bertrand</au><au>Duléry, Rémy</au><au>Bigé, Naïke</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcome of allogeneic hematopoietic stem cell transplant recipients admitted to the intensive care unit with a focus on haploidentical graft and sequential conditioning regimen: results of a retrospective study</atitle><jtitle>Annals of Hematology</jtitle><stitle>Ann Hematol</stitle><date>2021-11-01</date><risdate>2021</risdate><volume>100</volume><issue>11</issue><spage>2787</spage><epage>2797</epage><pages>2787-2797</pages><issn>0939-5555</issn><eissn>1432-0584</eissn><abstract>Haploidentical transplantation has extended the availability of allogeneic hematopoietic stem cell transplant (alloHCT) to almost all patients. Sequential conditioning regimens have been proposed for the treatment of hematological active disease. Whether these new transplantation procedures affect the prognosis of critically ill alloHCT recipients remains unknown. We evaluated this question in a retrospective study including consecutive alloHCT patients admitted to the intensive care unit of a tertiary academic center from 2010 to 2017. During the study period, 412 alloHCTs were performed and 110 (27%) patients—median age 55 (36–64) years—were admitted to ICU in a median time of 58.5 (14–245) days after alloHCT. Twenty-nine (26%) patients had received a haploidentical graft and 34 (31%) a sequential conditioning. Median SOFA score was 9 (6–11). Invasive mechanical ventilation (MV) was required in 61 (55%) patients. Fifty-six (51%) patients died in the hospital. Independent factors associated with in-hospital mortality were as follows: MV (OR=8.44 [95% CI 3.30–23.19],
p
<0.001), delta SOFA between day 3 and day 1 (OR=1.60 [95% CI 1.31–2.05],
p
<0.0001), and sequential conditioning (OR=3.7 [95% CI 1.14–12.92],
p
=0.033). Sequential conditioning was also independently associated with decreased overall survival (HR=1.86 [95% CI 1.05–3.31],
p
=0.03). Other independent factors associated with reduced overall survival were HCT-specific comorbidity index ≥2 (HR=1.76 [95% CI 1.10–2.84],
p
=0.02), acute GVHD grade ≥2 (HR=1.88 [95% CI 1.14–3.10],
p
=0.01), MV (HR=2.37 [95% CI 1.38–4.07,
p
=0.002), and vasopressors (HR=2.21 [95% CI 1.38–3.54],
p
=0.001). Haploidentical transplantation did not affect outcome. Larger multicenter studies are warranted to confirm these results.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><doi>10.1007/s00277-021-04640-7</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-2945-6293</orcidid><orcidid>https://orcid.org/0000-0003-4471-418X</orcidid><orcidid>https://orcid.org/0000-0002-7643-6770</orcidid><orcidid>https://orcid.org/0000-0002-2253-1844</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Hematology Intensive care Life Sciences Medical prognosis Medicine Medicine & Public Health Oncology Original Article Stem cell transplantation |
title | Outcome of allogeneic hematopoietic stem cell transplant recipients admitted to the intensive care unit with a focus on haploidentical graft and sequential conditioning regimen: results of a retrospective study |
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