Survival Outcome of Hematopoietic Stem Cell Transplant Recipients Admitted to the Intensive Care Unit: A Single-Center Report of 53 Patients

BACKGROUND: Intensive care unit (ICU) admission following hematopoietic stem cell transplantation (HSCT) has traditionally been associated with a poor prognosis; particularly for those patients requiring mechanical ventilation.

OBJECTIVE: To determine 28-day and 1-year survival of patients admitted to the ICU following autologous or allogeneic HSCT. Data was collected from a single transplant center.

STUDY DESIGN: Retrospective cohort study of all adult patients who received a HSCT at Vancouver General Hospital from April 1^st, 2000 to July 31^st, 2006.

RESULTS: During the 6 year period of the study, a total of 862 hematopoietic stem cell transplants were performed (367 allogeneic, 486 autologous). Overall 28-day and 1-year survival for those receiving an allogeneic transplant was 97.6% and 68.4%. Patients receiving an autologous transplant had a 28-day and 1-year survival of 98.4% and 78.0% respectively. Fifty-three (6%) of our cohort were admitted to the ICU (34 allogeneic, 19 autologous), of which 43 (81%) required mechanical ventilation. The 28-day and 1-year survival of those patients admitted to the ICU was 42/53 (79.3%) and 18/53 (34.0%), respectively. Recipients of allogeneic stem cell transplants had a 28-day and 1-year survival of 26/34 (76.5%) and 9/34 (26.5%). This is in comparison to 28-day and 1-year survival of 16/19 (84.2%) and 9/19 (47.4%) for those receiving autologous stem cell transplants.

CONCLUSION: These data indicate that the survival of HSCT patients who require ICU admission is better than what has been previously reported in the literature. Limitations of this study include potential selection bias in those patients admitted to the intensive care unit. Future research will be directed at finding prognostic factors for ICU admission. However, based on these results, patients who receive hematopoietic stem cell transplantation should be offered admission to the ICU.