title: Improved intensive care unit survival for critically ill allogeneic haematopoietic stem cell transplant recipients following reduced intensity conditioning.
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.
authors.affiliation: Department of Haematology, University College London Hospitals NHS Foundation Trust and UCL Medical School, London, UK.
authors.forename: William M
authors.initials: WM
authors.lastname: Townsend
authors.forename: Ailsa
authors.initials: A
authors.lastname: Holroyd
authors.forename: Rachel
authors.initials: R
authors.lastname: Pearce
authors.forename: Stephen
authors.initials: S
authors.lastname: Mackinnon
authors.forename: Prakesh
authors.initials: P
authors.lastname: Naik
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Goldstone
authors.forename: David C
authors.initials: DC
authors.lastname: Linch
authors.forename: Karl S
authors.initials: KS
authors.lastname: Peggs
authors.forename: Kirsty J
authors.initials: KJ
authors.lastname: Thomson
authors.forename: Mervyn
authors.initials: M
authors.lastname: Singer
authors.forename: David C J
authors.initials: DC
authors.lastname: Howell
authors.forename: Emma C
authors.initials: EC
authors.lastname: Morris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult