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World J Clin Oncol. Feb 10, 2016; 7(1): 98-105
Published online Feb 10, 2016. doi: 10.5306/wjco.v7.i1.98
Intensive care outcomes in adult hematopoietic stem cell transplantation patients
Ulas D Bayraktar, Joseph L Nates
Ulas D Bayraktar, Department of Stem Cell Transplantation, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Joseph L Nates, Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Author contributions: Bayraktar UD and Nates JL wrote the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Joseph L Nates, MD, MBA, Department of Critical Care, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 112, Houston, TX 77030, United States. jlnates@mdanderson.org
Telephone: +1-713-7925040 Fax: +1-713-7451869
Received: June 3, 2015
Peer-review started: June 3, 2015
First decision: August 10, 2015
Revised: September 29, 2015
Accepted: November 13, 2015
Article in press: November 17, 2015
Published online: February 10, 2016
Abstract

Although outcomes of intensive care for patients undergoing hematopoietic stem cell transplantation (HSCT) have improved in the last two decades, the short-term mortality still remains above 50% among allogeneic HSCT patients. Better selection of HSCT patients for intensive care, and consequently reduction of non-beneficial care, may reduce financial costs and alleviate patient suffering. We reviewed the studies on intensive care outcomes of patients undergoing HSCT published since 2000. The risk factors for intensive care unit (ICU) admission identified in this report were primarily patient and transplant related: HSCT type (autologous vs allogeneic), conditioning intensity, HLA mismatch, and graft-versus-host disease (GVHD). At the same time, most of the factors associated with ICU outcomes reported were related to the patients’ functional status upon development of critical illness and interventions in ICU. Among the many possible interventions, the initiation of mechanical ventilation was the most consistently reported factor affecting ICU survival. As a consequence, our current ability to assess the benefit or futility of intensive care is limited. Until better ICU or hospital mortality prediction models are available, based on the available evidence, we recommend practitioners to base their ICU admission decisions on: Patient pre-transplant comorbidities, underlying disease status, GVHD diagnosis/grade, and patients’ functional status at the time of critical illness.

Keywords: Stem cell transplantation, Intensive care, Mechanical ventilation, Comorbidity, Outcome prediction

Core tip: The outcome of hematopoietic stem cell transplantation (HSCT) patients admitted to intensive care remains poor but not “futile”. While risk factors for intensive care unit (ICU) admission are mostly patient and transplant related, prognostic factors for HSCT patients admitted to ICU are primarily related to patients’ functional status and interventions in ICU. Based on the available evidence, we recommend patient selection for ICU to be based on patient pre-transplant comorbidities, underlying disease status, graft-versus-host disease diagnosis/grade, and patients’ functional status at the time of critical illness.