Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Allografting

Outcome in critically ill patients with allogeneic BM or peripheral haematopoietic SCT: a single-centre experience

Bone Marrow Transplantation volume 46, pages 1186–1191 (2011)Cite this article

Subjects

Abstract

Outcome in haematological patients who develop critical illness has significantly improved over the last two decades, but less so in allogeneic BMT recipients. We prospectively investigated the outcome of 44 haematological patients with allogeneic BM or haematopoietic SCT (ABMT/AHSCT) requiring admission to the intensive care unit (ICU) of Ghent University Hospital between January 2000 and December 2007. We related outcome to the cause of critical illness, which was categorized as documented or clinically suspected bacterial infection, non-bacterial infection and non-infectious disease. Mechanical ventilation was required in 32 patients, and 12 patients received renal replacement therapy. Overall ICU-mortality, in-hospital mortality and 6-month mortality rates were 61, 75 and 80%, respectively. Hospital mortality rates in patients with bacterial infection (n=14), non-bacterial infection (n=13) and non-infectious disease (n=17) were 43, 85 and 94% (P=0.003). After adjustment for severity of illness sequential organ failure assessment (SOFA) score, bacterial infection (odds ratio 0.06, 0.01–0.36, P=0.002) was associated with significantly lower odds for hospital mortality. On the basis of our experience, ICU referral of ABMT/AHSCT patients is justifiable, as an acceptable fraction of these patients have longer-term survival. Documented or clinically suspected bacterial infection as the cause of critical illness is associated with better prognosis in comparison with other causes.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Clift RA, Buckner CD, Appelbaum FR, Bearman SI, Petersen FB, Fisher LD et al. Allogeneic marrow transplantation in patients with acute myeloid leukemia in first remission. A randomized trial of two irradiation regimens. Blood 1990; 76: 1867–1871.

    CAS  PubMed  Google Scholar 

  2. Crawford SW, Schwartz DA, Peterson FB, Clark JG . Mechanical ventilation after marrow transplantation: risk factors and clinical outcome. Am Rev Respir Dis 1988; 137: 682–687.

    Article  CAS  PubMed  Google Scholar 

  3. Torrecilla C, Cortes JL, Chamorro C, Rubio JJ, Galdos P, Devillota ED . Prognostic assessment of the acute complications of bone marrow transplantation requiring intensive therapy. Intensive Care Med 1988; 14: 393–398.

    Article  CAS  PubMed  Google Scholar 

  4. Scales DC, Thiruchelvam D, Kiss A, Sibbald WJ, Redelmeier DA . Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis. Crit Care 2008; 12: R77.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Faber-Langendoen K, Caplan AL, McGlave PB . Survival of adult bone marrow transplant patients receiving mechanical ventilation: a case for restricted use. Bone Marrow Transplant 1993; 12: 501–507.

    CAS  PubMed  Google Scholar 

  6. Caplan A . Odds and ends: trust and debate over medical futility. Ann Intern Med 1996; 125: 688–689.

    Article  CAS  PubMed  Google Scholar 

  7. Klingemann HG . Mechanical ventilation for bone marrow transplant patient: when does it become futile? Crit Care Med 2000; 28: 899–900.

    Article  CAS  PubMed  Google Scholar 

  8. Rubenfeld GD, Crawford BW . Withdrawing life support from mechanically ventilated recipients of bone marrow transplants: a case for evidence-based guidelines. Ann Intern Med 1996; 125: 625–633.

    Article  CAS  PubMed  Google Scholar 

  9. Paz HL, Garland A, Weinar M, Crilley P, Brodsky I . Effect of clinical outcomes data on intensive care unit utilization by bone marrow transplant patients. Crit Care Med 1998; 26: 66–70.

    Article  CAS  PubMed  Google Scholar 

  10. Bach PB, Schrag D, Nierman DM, Horak D, White P, Young JW et al. Identification of poor prognostic factors among patients requiring mechanical ventilation after hematopoietic stem cell transplantation. Blood 2001; 98: 3234–3240.

    Article  CAS  PubMed  Google Scholar 

  11. Azoulay E, Thiery G, Chevret S, Moreau D, Darmon M, Bergeron A et al. The prognosis of acute respiratory failure in critically ill cancer patients. Medicine 2004; 83: 360–370.

    Article  PubMed  Google Scholar 

  12. Benoit D, Depuydt P, Peleman RA, Offner FC, Vandewoude KH, Vogelaers DP et al. Documented and clinically suspected bacterial infection precipitating intensive care unit admission in patients with hematological malignancies: impact on outcome. Intensive Care Med 2005; 31: 934–942.

    Article  PubMed  Google Scholar 

  13. Azoulay E, Mokart D, Rabbat A, Pene F, Kouatchet A, Bruneel F et al. Diagnostic bronchoscopy in hematology and oncology patients with acute respiratory failure : prospective multicentre data. Crit Care Med 2008; 36: 100–107.

    Article  PubMed  Google Scholar 

  14. Vandijck D, Benoit D, Depuydt P, Offner FC, Blot S, Van Tilborgh A et al. Impact of recent intravenous chemotherapy on outcome in severe sepsis and septic shock patients with hematological malignancies. Intensive Care Med 2008; 34: 847–855.

    Article  PubMed  Google Scholar 

  15. Knaus WA, Draper EA, Wagner DP, Zimmerman JE . APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818–829.

    Article  CAS  PubMed  Google Scholar 

  16. Le Gall JR, Lemeshow S, Saulnier F . A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993; 270: 2957–2963.

    Article  CAS  PubMed  Google Scholar 

  17. Groeger JS, Lemeshow S, Price K, Nierman DM, White J, Klar J et al. Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model. J Clin Oncol 1998; 16: 761–770.

    Article  CAS  PubMed  Google Scholar 

  18. Vincent JL, De Mendonca A, Cantraine F, Moreno R, Takkala J, Suter PM et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Crit Care Med 1998; 26: 1793–1800.

    Article  CAS  PubMed  Google Scholar 

  19. Ascioglu S, Rex JH, de Pauw B, Bennet JE, Bille J, Crokaert F et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002; 34: 7–14.

    Article  CAS  PubMed  Google Scholar 

  20. Ball LM, Egeler RM, on behalf of the EBMT Paediatric Working Party. Acute GvHD: pathogenesis and classification. Bone Marrow Transplant 2008; 41: 558–564.

    Article  Google Scholar 

  21. Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ et al. NIH consensus development project on criteria for clinical trials in chronic graft versus host disease: I. diagnosis and staging working group report. Biol Blood Marrow Transplant 2005; 11: 945–955.

    Article  PubMed  Google Scholar 

  22. Pene F, Aubron C, Azoulay E, Blot F, Thiery G, Raynard B et al. Outcome of critically ill allogeneic bone marrow transplantation recipients: a reappraisal of indications for organ failure supports. J Clin Oncol 2006; 24: 643–949.

    Article  PubMed  Google Scholar 

  23. Azoulay E, Moreau D, Alberti C, Leleu G, Adrie C, Barboteu M et al. Predictors of short-term mortality in critically ill patients with solid malignancies. Intensive Care Med 2000; 26: 1817–1823.

    Article  CAS  PubMed  Google Scholar 

  24. Adam AK, Soubani AO . Outcome and prognostic factors of lung cancer patients admitted to the intensive care unit. Eur Respir J 2008; 31: 47–53.

    Article  CAS  PubMed  Google Scholar 

  25. Lim Z, Pagliuca A, Simpson S, Cottam S, Ervine M, Ho A et al. Outcomes of patients with haematological malignancies admitted to intensive care unit. A comparative review of allogeneic haematopoietic stem cell transplantation data. Br J Haematol 2007; 136: 448–450.

    Article  PubMed  Google Scholar 

  26. Soares M, Depuydt P, Salluh J . Mechanical ventilation in cancer patients: clinical characteristics and outcomes. Crit Care Clin 2010; 26: 41–58.

    Article  PubMed  Google Scholar 

  27. Depuydt P, Benoit D, Vandewoude K, Decruyenaere JM, Colardyn F . Outcome in noninvasively and invasively ventilated patients with acute respiratory failure. Chest 2004; 126: 1299–1306.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Mrs Hadewych Meyns, study nurse, for her help in retrieving additional information from the patient's medical files.

Author information

Authors and Affiliations

  1. Department of Intensive Care, Ghent University Hospital, Ghent, Belgium

    P Depuydt, J Nollet & D Benoit

  2. Department of Hematology, Ghent University Hospital, Ghent, Belgium

    T Kerre, L Noens, F Offner & J Decruyenaere

  3. Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium

    P Depuydt

Authors
  1. P Depuydt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T Kerre
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L Noens
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J Nollet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F Offner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J Decruyenaere
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D Benoit
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P Depuydt.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Depuydt, P., Kerre, T., Noens, L. et al. Outcome in critically ill patients with allogeneic BM or peripheral haematopoietic SCT: a single-centre experience. Bone Marrow Transplant 46, 1186–1191 (2011). https://doi.org/10.1038/bmt.2010.255

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2010.255

Keywords

This article is cited by

Search

Advanced search

Quick links