Intensive Care Outcomes of Patients after High Dose Chemotherapy and Subsequent Autologous Stem Cell Transplantation: A Retrospective, Single Centre Analysis

High dose chemotherapy (HDT) followed by autologous peripheral blood stem cell transplantation (ASCT) is standard of care including a curative treatment option for several cancers. While much is known about the management of patients with allogenic SCT at the intensive care unit (ICU), data regarding incidence, clinical impact, and outcome of critical illness following ASCT are less reported. This study included 256 patients with different cancer entities. Median age was 56 years (interquartile ranges (IQR): 45–64), and 67% were male. One-year survival was 89%; 15 patients (6%) required treatment at the ICU following HDT. The main reason for ICU admission was septic shock (80%) with the predominant focus being the respiratory tract (53%). Three patients died, twelve recovered, and six (40%) were alive at one-year, resulting in an immediate treatment-related mortality of 1.2%. Independent risk factors for ICU admission were age (odds ratio (OR) 1.05; 95% confidence interval (CI) 1.00–1.09; p = 0.043), duration of aplasia (OR: 1.37; CI: 1.07–1.75; p = 0.013), and Charlson comorbidity score (OR: 1.64; CI: 1.20–2.23; p = 0.002). HDT followed by ASCT performed at an experienced centre is generally associated with a low risk for treatment related mortality. ICU treatment is warranted mainly due to infectious complications and has a strong positive impact on intermediate-term survival.

[1]  M. Slavin,et al.  Epidemiology, treatment and outcomes of bloodstream infection due to vancomycin-resistant enterococci in cancer patients in a vanB endemic setting , 2020, BMC Infectious Diseases.

[2]  A. Shimabukuro-Vornhagen,et al.  [Hematological-oncological intensive care patients : Treatment without borders]. , 2019, Medizinische Klinik, Intensivmedizin und Notfallmedizin.

[3]  M. Gardam,et al.  Patient‐ and hospital‐level predictors of vancomycin‐resistant Enterococcus (VRE) bacteremia in Ontario, Canada , 2018, American journal of infection control.

[4]  W. Sperr,et al.  Consensus statement for cancer patients requiring intensive care support , 2018, Annals of Hematology.

[5]  N. Hanna,et al.  High-Dose Chemotherapy and Autologous Peripheral-Blood Stem-Cell Transplantation for Relapsed Metastatic Germ Cell Tumors: The Indiana University Experience. , 2017, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[6]  H. Goldschmidt,et al.  Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  M. Wujtewicz,et al.  The effectiveness of the APACHE II, SAPS II and SOFA prognostic scoring systems in patients with haematological malignancies in the intensive care unit. , 2014, Anaesthesiology intensive therapy.

[8]  S. Chevret,et al.  Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium--a groupe de recherche respiratoire en réanimation onco-hématologique study. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[9]  S. Chevret,et al.  Outcomes in Critically Ill Cancer Patients With Septic Shock of Pulmonary Origin , 2013, Shock.

[10]  N. D. de Keizer,et al.  Outcomes of cancer patients after unplanned admission to general intensive care units , 2012, Acta oncologica.

[11]  R. Boots,et al.  Intensive care unit experience of haemopoietic stem cell transplant patients , 2012, Internal medicine journal.

[12]  A. Moreau,et al.  Outcomes of mechanically ventilated hematology patients with invasive pulmonary aspergillosis , 2011, Intensive Care Medicine.

[13]  S. Pastores,et al.  Intensive care of the cancer patient: recent achievements and remaining challenges , 2011, Annals of intensive care.

[14]  K. Laczika,et al.  Prognostic factors for intensive care unit admission, intensive care outcome, and post-intensive care survival in patients with de novo acute myeloid leukemia: a single center experience , 2011, Haematologica.

[15]  N. Schmitz,et al.  Salvage regimens with autologous transplantation for relapsed large B-cell lymphoma in the rituximab era. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[16]  M. Ostermann,et al.  ICU and 6-month outcome of oncology patients in the intensive care unit. , 2010, QJM : monthly journal of the Association of Physicians.

[17]  J. M. Teles,et al.  Characteristics and outcomes of patients with cancer requiring admission to intensive care units: A prospective multicenter study* , 2010, Critical care medicine.

[18]  U. Mellqvist,et al.  OUTCOME OF AUTOLOGOUS STEM CELL TRANSPLANTATION FOR AL-AMYLOIDOSIS IN SWEDEN in HAEMATOLOGICA-THE HEMATOLOGY JOURNAL, vol 95, issue , pp 393-393 , 2010 .

[19]  S. Lapinsky,et al.  Predictors of mortality in patients undergoing autologous hematopoietic cell transplantation admitted to the intensive care unit , 2009, Bone Marrow Transplantation.

[20]  J. Ledermann,et al.  High dose chemotherapy with autologous hematopoietic stem cell support for solid tumors other than breast cancer in adults. , 2006, Annals of oncology : official journal of the European Society for Medical Oncology.

[21]  P. Hawkins,et al.  Outcome of autologous stem cell transplantation for AL amyloidosis in the UK , 2006, British journal of haematology.

[22]  M. Tan,et al.  High‐dose methotrexate pharmacokinetics and outcome of children and young adults with osteosarcoma , 2004, Cancer.

[23]  É. Azoulay,et al.  Improved survival of critically ill cancer patients with septic shock , 2003, Intensive Care Medicine.

[24]  P. Thall,et al.  Prognostic indicators for blood and marrow transplant patients admitted to an intensive care unit. , 1998, American journal of respiratory and critical care medicine.

[25]  J. Vose,et al.  Rapid immunologic reconstitution following transplantation with mobilized peripheral blood stem cells as compared to bone marrow , 1997, Bone Marrow Transplantation.

[26]  G. Tricot,et al.  Dose-intensive chemotherapy in refractory germ cell cancer--a phase I/II trial of high-dose carboplatin and etoposide with autologous bone marrow transplantation. , 1989, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[27]  S. Rosenberg,et al.  Patterns of recurrence in patients with high-grade soft-tissue sarcomas. , 1985, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.