Outcome of allogeneic hematopoietic stem cell transplant recipients admitted to the intensive care unit with a focus on haploidentical graft ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2021-09-03

AUTHORS

Viviane Gournay, Guillaume Dumas, Jean-Rémi Lavillegrand, Geoffroy Hariri, Tomas Urbina, Jean-Luc Baudel, Hafid Ait-Oufella, Eric Maury, Eolia Brissot, Ollivier Legrand, Florent Malard, Mohamad Mohty, Bertrand Guidet, Rémy Duléry, Naïke Bigé

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. More... »

PAGES

2787-2797

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  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00277-021-04640-7

    DOI

    http://dx.doi.org/10.1007/s00277-021-04640-7

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1140861504

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/34476574


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