Outcomes and Long-Term Survival of Adolescent and Young Adult Patients Admitted to the Intensive Care Unit Following Allogeneic Hematopoietic Stem Cell Transplantation: A Single-Centre Experience of 152 Patients

Abstract

Objective: Prognostic factors reliably predicting outcomes for critically ill adolescent and young adult (AYA) patients undergoing allogeneic hematopoietic cell transplantation (allo-HSCT) are lacking. We assessed transplant and intensive care unit (ICU)-related factors impacting patient outcomes. Design: Retrospective review Setting: Tertiary care Centre, during the period of 2003-2013 Patients: AYA patients who underwent allo-HSCT and required ICU admission. Interventions: This was a non-interventional study. Only outcomes after first allo-HSCT and index ICU admissions were analyzed. Disease-, transplant-, and ICU-related variables were analyzed to identify risk factors predictive of survival. Measurements and Main Results: Overall, 152 patients were included (males, 60.5%); median age at transplantation was 24 years (IQR 18-32.5); median age at admission to the ICU was 25.8 years (IQR 19-34). Eighty-four percent underwent transplantation for a hematological malignancy; 129 (85%) received myeloablative conditioning. Seventy-one percent of ICU admissions occurred within the first year after allo-HSCT. ICU admission was primarily due to respiratory failure (47.3%) and sepsis (43.4%). One hundred three patients (68%) died within 28 days of ICU admission. The 1-year and 5-year overall survival (OS) rates were 19% and 17%, respectively. Main causes for ICU-related death were refractory septic shock with multiorgan failure (n=49, 32%) and acute respiratory distress syndrome (ARDS) (n=39, 26%). Univariate analysis showed that ICU mortality was associated with an Acute Physiology and Chronic Health Evaluation (APACHE) II score > 20, a sequential organ failure assessment (SOFA score) > 12, a high lactate level, anemia, thrombocytopenia, leukopenia, hyperbilirubinemia, a high international normalized ratio (INR) and acute GVHD. Multivariate analysis identified thrombocytopenia, high INR, and acute GVHD as independent predictors of mortality. Conclusions: In AYA allo-HSCT patients admitted to the ICU, mortality remains high. Higher SOFA and APACHE scores, need for organ support, thrombocytopenia, coagulopathy, and acute GVHD predict poor outcomes.

Recommended Citation

Solaiman, Othman M.; Elhassan, Tusneem; El Fakih, Riad; Mannan, Abdul; Alduhailib, Zainab; Mahdali, Ashwaq A.; Alzahrani, Hazzaa; Jamil, Mouhamad; Chaudhri, Naeem; Elhazmi, Alyaa; Kolko, Mohammad; Al-Sharif, Fahad Z.; Alrbiaan, Abdullah; Shaban, Mohammed; Shaheen, Marwan; Salahuddin, Nawal; Alfraih, Feras A.; Altarifi, Ashraf S.; Hassanein, Mona; Hosaini, Sulaiman; Alhashim, Noura; Mohamed, Alaa Abdelhafiz; Hanbali, Amr; Aljanoubi, Ali Hussein; Al-Obaidi, Nadia R.; Rasheed, Walid; Maghrabi, Khalid; Almohareb, Fahad; Soubani, Ayman; Aljurf, Mahmoud; and Ahmed, Syed Osman (2024) "Outcomes and Long-Term Survival of Adolescent and Young Adult Patients Admitted to the Intensive Care Unit Following Allogeneic Hematopoietic Stem Cell Transplantation: A Single-Centre Experience of 152 Patients," Hematology/Oncology and Stem Cell Therapy: Vol. 17 : Iss. 2 , Article 3.
Available at: https://doi.org/10.56875/2589-0646.1114