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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Veröffentlicht in:Annals of Hematology 2021-11, Vol.100 (11), p.2787-2797
Hauptverfasser: 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
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container_issue 11
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container_title Annals of Hematology
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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], p
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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 &lt;0.001), delta SOFA between day 3 and day 1 (OR=1.60 [95% CI 1.31–2.05], p &lt;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. 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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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