title: Short- and long-term outcomes of adult allogeneic hematopoietic stem cell transplant patients admitted to the intensive care unit in the peritransplant period.
abstract: Survival of allogeneic hematopoietic stem cell transplant (aHSCT) recipients in the intensive care unit (ICU) has been poor. We retrospectively analyzed the short- and long-term outcomes of aHSCT patients admitted to the ICU over a 12-year period. Of 1235 adult patients who had aHSCT between 2002 and 2013, 161 (13%) were admitted to the ICU. The impact of clinical parameters was assessed and outcomes were compared for the periods 2002-2007 and 2008-2013. The ICU, in-hospital, 1- and 5-year survival rates were 64.6%, 46%, 33% and 20%, respectively. Mechanical ventilation and vasopressor use predicted for worse hospital- and overall survival (OS). After 2008, the requirement for mechanical ventilation and vasopressors, and the diagnosis of sepsis were reduced. While hospital mortality decreased from 69% to 44%, long-term survival (LTS) remained unchanged. Late deaths, due to causes not associated with the ICU such as relapse and graft-versus-host disease, increased. As thresholds for transplant are lowered, improvements in ICU outcomes for aHSCT recipients may be limited.
authors.affiliation: a Department of Medicine , New York Presbyterian Hospital, Joan and Sanford I Weill Medical College, Cornell University , New York , USA.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Mayer
authors.affiliation: a Department of Medicine , New York Presbyterian Hospital, Joan and Sanford I Weill Medical College, Cornell University , New York , USA.|b Departments of Anesthesiology and Critical Care Medicine , Memorial Sloan-Kettering Cancer Center , New York , USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Pastores
authors.affiliation: c Epidemiology and Biostatistics , Memorial Sloan-Kettering Cancer Center , New York , USA.
authors.forename: Elyn
authors.initials: E
authors.lastname: Riedel
authors.affiliation: d Memorial Sloan Kettering Cancer Center , New York , USA.
authors.forename: Molly
authors.initials: M
authors.lastname: Maloy
authors.affiliation: e Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , USA.|f Joan and Sanford I Weill Cornell Medical College, Cornell University , New York , New York , USA.
authors.forename: Ann A
authors.initials: AA
authors.lastname: Jakubowski
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D059035:Perioperative Period; D012189:Retrospective Studies; D019172:Transplantation Conditioning; D055815:Young Adult
keywords: Allogeneic; intensive care; mortality; prognostic factors; stem cell transplantation