Outcomes after intensive care unit admission in newly diagnosed diffuse large B‐cell lymphoma patients: A real‐life study

We conducted a retrospective study to analyze the prognostic factors impacting the overall survival (OS) and progression‐free survival (PFS) of diffuse large B‐cell lymphoma (DLBCL) patients undergoing first‐line therapy and admitted to intensive care unit (ICU) compared to a control cohort who did not required ICU admission. Between January 1, 2008, and December 31, 2018, 828 patients were diagnosed with DLBCL at our institution, including 72 patients who were required ICU admission during disease course. Among them, forty‐five patients undergoing homogeneous first‐line therapy with /R‐CHOP‐like regimen and ICU‐admitted were selected for the present analysis. Control “non‐ICU” DLBCL patients were matched by age, IPI score and treatment received. The median age at ICU admission was 65 years, 97.8% of patients displayed advanced‐stage disease (III/IV), and 84.4% had a high IPI score (3‐5). The main reasons for ICU admission were acute respiratory failure (40.0%) and septic shock (33.3%). The ICU mortality rate was 33.3%. The 2‐year PFS was lower in ICU survivors patients than in non‐ICU patients: 31.7% (95% CI 18.5‐54.1) vs 60.8% (95% CI 51.2‐72.1, P = .00049). Admission to the ICU is an event that clearly impacts the outcomes of patients with DLBCL, until 2 years after the event. ICU prognosis seems mainly related to critical patient severity at admission rather than lymphoma‐related prognostic factors (IPIs), suggesting that ICU admission criteria should not be based only on the lymphoma prognosis.

[1]  S. Chevret,et al.  Direct admission to the intensive care unit from the emergency department and mortality in critically ill hematology patients , 2019, Annals of Intensive Care.

[2]  A. Shimabukuro-Vornhagen,et al.  Prognostic accuracy of SOFA, qSOFA and SIRS criteria in hematological cancer patients: a retrospective multicenter study , 2019, Journal of Intensive Care.

[3]  D. Toledo,et al.  The use of computed tomography images as a prognostic marker in critically ill cancer patients. , 2018, Clinical nutrition ESPEN.

[4]  B. Winkens,et al.  The prognostic value of a trend in modified SOFA score for patients with hematological malignancies in the intensive care unit , 2017, European journal of haematology.

[5]  J. Cerhan,et al.  2016 US lymphoid malignancy statistics by World Health Organization subtypes , 2016, CA: a cancer journal for clinicians.

[6]  M. Churpek,et al.  Sequential Organ Failure Assessment Score Modified for Recent Infection in Patients With Hematologic Malignant Tumors and Severe Sepsis. , 2016, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[7]  L. Spanjaard,et al.  Haematological malignancy in the intensive care unit: microbiology results and mortality , 2016, European journal of haematology.

[8]  R. Green,et al.  Predictors of Poor Outcomes in Critically Ill Adults with Hematologic Malignancy , 2016, Canadian respiratory journal.

[9]  U. Jäger,et al.  Incidence of intensive care unit admission, outcome and post intensive care survival in patients with diffuse large B-cell lymphoma , 2016, Leukemia & lymphoma.

[10]  Adil Rafiq Rather,et al.  The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) , 2015 .

[11]  V. Gašparović,et al.  Hematologic malignancies in the medical intensive care unit – Outcomes and prognostic factors , 2015, Hematology.

[12]  F. Jardin,et al.  Prognostic impact of fat tissue loss and cachexia assessed by computed tomography scan in elderly patients with diffuse large B‐cell lymphoma treated with immunochemotherapy , 2014, European journal of haematology.

[13]  J. Cerhan,et al.  Event-free survival at 24 months is a robust end point for disease-related outcome in diffuse large B-cell lymphoma treated with immunochemotherapy. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  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.

[15]  M Ladetto,et al.  Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. , 2012, Annals of oncology : official journal of the European Society for Medical Oncology.

[16]  A. Scally,et al.  Survival of patients with hematological malignancy admitted to the intensive care unit: prognostic factors and outcome compared to unselected medical intensive care unit admissions, a parallel group study , 2012, Leukemia & lymphoma.

[17]  T. Molina,et al.  Intensified chemotherapy with ACVBP plus rituximab versus standard CHOP plus rituximab for the treatment of diffuse large B-cell lymphoma (LNH03-2B): an open-label randomised phase 3 trial , 2011, The Lancet.

[18]  S. Pinto‐Sietsma,et al.  Prognosis of patients with haematological malignancies admitted to the intensive care unit: Sequential Organ Failure Assessment (SOFA) trend is a powerful predictor of mortality. , 2011, European journal of internal medicine.

[19]  J. Decruyenaere,et al.  Impact of organ dysfunction on mortality in ICU patients with hematologic malignancies , 2010, Intensive Care Medicine.

[20]  K. Ohta,et al.  Impact of relative dose intensity (RDI) in CHOP combined with rituximab (R-CHOP) on survival in diffuse large B-cell lymphoma , 2009, Journal of experimental & clinical cancer research : CR.

[21]  Tony Reiman,et al.  A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. , 2008, Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme.

[22]  Z. Berneman,et al.  Achievement of optimal average relative dose intensity and correlation with survival in diffuse large B-cell lymphoma patients treated with CHOP , 2008, Annals of Hematology.

[23]  F. Dachraoui,et al.  Changes in severity and organ failure scores as prognostic factors in onco-hematological malignancy patients admitted to the ICU , 2006, Intensive Care Medicine.

[24]  Randy D Gascoyne,et al.  Rituximab-CHOP versus CHOP alone or with maintenance rituximab in older patients with diffuse large B-cell lymphoma. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[25]  A. López-Guillermo,et al.  CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. , 2006, The Lancet. Oncology.

[26]  M. Paesmans,et al.  Is a specific oncological scoring system better at predicting the prognosis of cancer patients admitted for an acute medical complication in an intensive care unit than general gravity scores? , 2004, Supportive Care in Cancer.

[27]  J. Vincent,et al.  The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure , 1996, Intensive Care Medicine.

[28]  D. G. Altman,et al.  Review of survival analyses published in cancer journals. , 1995, British Journal of Cancer.

[29]  Y. Hochberg.  A sharper Bonferroni procedure for multiple tests of significance , 1988 .

[30]  J. E. Carceller,et al.  Guidelines for intensive care unit admission, discharge, and triage Task Force of the American College of Critical Care Medicine, Society of Critical Care Medcine , 1999, Critical care medicine.

[31]  S. Lemeshow,et al.  A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. , 1993, JAMA.