Poor Prognosis for Patients after Myelo- and Non-Myeloablative Conditioning Therapy Followed by Allogeneic Peripheral Blood Stem Cell Transplantation Admitted to Intensive Care Unit.

Background and Aims: The role of intensive care unit (ICU) support for patients following allogeneic peripheral blood stem cell transplantation (PBSCT) is controversial. In an era of constrained resources, we assessed prognostic factors predictive for survival in patients after myeloablative (MAC) and non-myeloablative allogeneic (non-MAC) PBSCT over a period of seven years.

Patients: Between January 1999 and February 2006 three-hundred and one patients with various hematological malignancies underwent allogeneic stem cell tranplantation in our institution (MAC 196, non-MAC 105). Of these, sixty-four patients (21,3%) with a median age of 47 years (range 18–64 years; female 24, male 40; MAC 49, non-MAC 15) were admitted to the ICU during the first two years following PBSCT (median 55 days, range 1–631 days). We looked for variables defining the SOFA (Sequential Organ Failure Assessment) and the SAPS (Simplified Acute Physiology Score) score on the day of ICU admission and five days later to discriminate patients with poor and good prognosis with regard to survival. We also looked for variables such as age of patients, diagnosis, disease status, donor type, time between transplantation and ICU admission, reason for ICU admission and occurrence of veno-occlusive disease and GVHD.

Results: Mechanical ventilation was required by all patients admitted to the ICU. Median survival following referral to ICU was 22 days (range 0 – 959 days). The main reason for death was sepsis (56%). Among 49 patients who had received MAC 19 (39%) survived the ICU stay with a median survival time of 11 months (range 0–29 months). In the group of patients who had received non-MAC 3 out of 15 patients (20%) could be discharged from the ICU with a median survival time of 5 months (range 4–12 months). Looking at the twenty-two ICU survivors there were seven patients who survived the following year resulting in an overall survival of 11% one year after ICU admission. Only the SOFA score (p = 0.002) on the day of ICU admission was of prognostic relevance for survival.

Conclusion: ICU admission and respiratory failure are associated with poor prognosis after allogeneic stem cell transplantation The probability of survival is independent from the type of conditioning therapy. The SOFA score is a predictor for short term survival but fails to identify long term survivors.