title: Incidence of intensive care unit admission, outcome and post intensive care survival in patients with diffuse large B-cell lymphoma.
abstract: Some patients with diffuse large B-cell lymphoma (DLBCL) require intensive care unit (ICU) admission prior to or during chemotherapy. We analyzed all unscheduled ICU admissions in 331 consecutive patients (18-93 years) with newly diagnosed DLBCL. Thirty-seven patients (11.2%) required ICU treatment primarily due to hemodynamic (37.8%) or respiratory failure (24.3%). Bulky disease and high IPI score were predictive of ICU admission in the early course. ICU and hospital survival was 75.7% and 70.3%, respectively. Overall survival in ICU patients with newly diagnosed DLBCL was worse compared to non-ICU-patients (40.7% vs. 72.7% at two years). However, survival of high-risk patients (IPI 3-5), continuous complete remission, and disease-free survival did not differ. Post-ICU survival was poor in patients with relapsed/refractory DLBCL (0.1-10 months). Our observations favor unrestricted ICU support in DLBCL patients undergoing first-line therapy. ICU referral of patients with refractory/relapsed disease must be evaluated in the context of the hematologic prognosis.
authors.affiliation: a Department of Medicine I, Intensive Care Unit 13i2 , Medical University of Vienna , Vienna , Austria ;
authors.forename: Philipp
authors.initials: P
authors.lastname: Wohlfarth
authors.affiliation: a Department of Medicine I, Intensive Care Unit 13i2 , Medical University of Vienna , Vienna , Austria ;
authors.forename: Alexander
authors.initials: A
authors.lastname: Carlström
authors.affiliation: a Department of Medicine I, Intensive Care Unit 13i2 , Medical University of Vienna , Vienna , Austria ;
authors.forename: Thomas
authors.initials: T
authors.lastname: Staudinger
authors.affiliation: a Department of Medicine I, Intensive Care Unit 13i2 , Medical University of Vienna , Vienna , Austria ;
authors.forename: Sabine
authors.initials: S
authors.lastname: Clauss
authors.affiliation: a Department of Medicine I, Intensive Care Unit 13i2 , Medical University of Vienna , Vienna , Austria ;
authors.forename: Alexander
authors.initials: A
authors.lastname: Hermann
authors.affiliation: a Department of Medicine I, Intensive Care Unit 13i2 , Medical University of Vienna , Vienna , Austria ;
authors.forename: Werner
authors.initials: W
authors.lastname: Rabitsch
authors.affiliation: a Department of Medicine I, Intensive Care Unit 13i2 , Medical University of Vienna , Vienna , Austria ;
authors.forename: Andja
authors.initials: A
authors.lastname: Bojic
authors.affiliation: b Department of Medicine I, Clinical Division of Hematology and Hemostaseology , Medical University of Vienna , Vienna , Austria ;
authors.forename: Cathrin
authors.initials: C
authors.lastname: Skrabs
authors.affiliation: b Department of Medicine I, Clinical Division of Hematology and Hemostaseology , Medical University of Vienna , Vienna , Austria ;
authors.forename: Edit
authors.initials: E
authors.lastname: Porpaczy
authors.affiliation: c Clinical Institute of Pathology , Medical University of Vienna , Vienna , Austria ;
authors.forename: Ana-Iris
authors.initials: AI
authors.lastname: Schiefer
authors.affiliation: b Department of Medicine I, Clinical Division of Hematology and Hemostaseology , Medical University of Vienna , Vienna , Austria ;
authors.forename: Peter
authors.initials: P
authors.lastname: Valent
authors.affiliation: b Department of Medicine I, Clinical Division of Hematology and Hemostaseology , Medical University of Vienna , Vienna , Austria ;
authors.forename: Paul
authors.initials: P
authors.lastname: Knöbl
authors.affiliation: b Department of Medicine I, Clinical Division of Hematology and Hemostaseology , Medical University of Vienna , Vienna , Austria ;
authors.forename: Hermine
authors.initials: H
authors.lastname: Agis
authors.affiliation: b Department of Medicine I, Clinical Division of Hematology and Hemostaseology , Medical University of Vienna , Vienna , Austria ;
authors.forename: Alexander
authors.initials: A
authors.lastname: Hauswirth
authors.affiliation: b Department of Medicine I, Clinical Division of Hematology and Hemostaseology , Medical University of Vienna , Vienna , Austria ;
authors.forename: Ulrich
authors.initials: U
authors.lastname: Jäger
authors.affiliation: d Institute of Environmental Health, Center for Public Health , Medical University of Vienna , Vienna , Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Kundi
authors.affiliation: a Department of Medicine I, Intensive Care Unit 13i2 , Medical University of Vienna , Vienna , Austria ;|b Department of Medicine I, Clinical Division of Hematology and Hemostaseology , Medical University of Vienna , Vienna , Austria ;
authors.forename: Wolfgang R
authors.initials: WR
authors.lastname: Sperr
authors.affiliation: a Department of Medicine I, Intensive Care Unit 13i2 , Medical University of Vienna , Vienna , Austria ;
authors.forename: Peter
authors.initials: P
authors.lastname: Schellongowski
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003422:Critical Care / Q000706:statistics & numerical data*; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: DLBCL; Diffuse large B-cell lymphoma; intensive care unit; respiratory failure; sepsis