Factors affecting survival in children requiring intensive care after hematopoietic stem cell transplantation. A retrospective single‐center study

Abstract

Allo‐HSCT is associated with life‐threatening complications. Therefore, a considerable number of patients require admission to a PICU. We evaluated the incidence and outcome of PICU admissions after allo‐HSCT in children, along with the potential factors influencing PICU survival. A retrospective chart review of 668 children who underwent first allo‐HSCT in the Department of Pediatric Hematology/Oncology and BMT in Wrocław during years 2005‐2017, particularly focusing on patients admitted to the PICU within 1‐year post‐HSCT. Fifty‐eight (8.7%) patients required 64 admissions to the PICU. Twenty‐four (41.5%) were discharged, and 34 (58.6%) patients died. Among the discharged patients, 6‐month survival was 66.7%. Compared with survivors, death cases were more likely to have required MV (31/34; 91.2% vs. 16/24; 66.7% P = .049), received more aggressive cardiac support (17/34; 50% vs. 2/24; 8.3% P = .002), and had a lower ANC on the last day of their PICU stay (P = .004). Five patients were successfully treated with NIV and survived longer than 6 months post‐discharge. The intensity of cardiac support and ANC on the last day of PICU treatment was independent factors influencing PICU survival. Children admitted to the PICU after allo‐HSCT have a high mortality rate. Mainly those who needed a more aggressive approach and had a lower ANC on the last day of treatment had a greater risk of death. While requiring MV is associated with decreased PICU survival, early implementation of NIV might be considered.

The Determining Factors for Outcome of Pediatric Intensive Care Admitted Children After Stem Cell Transplantation

“…The most common PICU admission indications are respiratory failure and septic shock in the study series similar to ours 9,23 . Neurological, renal, and cardiac causes, which are seen as transplant-related acute complications, are mostly seen within the first 100 days 24 …”

“…The length of stay had no impact on mortality in our study. Although some studies found a correlation between mortality and length of stay, there was no such relationship in others 7,15,23,25 …”

Short- and long-term outcome of allogeneic stem cell transplantation in infants: A single-center experience over 20 years

“…In the pre-engraftment period, high rates of PICU admissions (32%) and deaths due to sepsis (7.4%) were observed. This phenomenon highlights the elevated risk of allo-HSCT complications in the infant population ( 18 ). A mortality of 40.9% was reported before 2009, while 22.2% was observed during 2009–2019; the improvements in survival rates were similar to those in studies reporting only slow progress in this age group ( 1 – 4 ).…”

“…In the preengraftment period, high rates of PICU admissions (32%) and deaths due to sepsis (7.4%) were observed. This phenomenon highlights the elevated risk of allo-HSCT complications in the infant population (18) 2). In this study, the observed phenomena of excessive toxicity and mortality were associated with multiple factors.…”

Specialized Pediatric Palliative Care Services in Pediatric Hematopoietic Stem Cell Transplant Centers

“…HSCT is a successful therapy offering the possibility of a cure for life-threatening conditions; however, it is an intensive treatment with risk of serious complications, significant physical and psychological symptoms, poor quality of life (QoL), and can be lethal [3][4][5][6]. As reported in previous studies, pediatric patients who died following HSCT were often treated in the pediatric intensive care unit (PICU) with invasive treatments during End-of-Life (EOL) [4,[6][7][8]. Of these studies, three showed that pediatric HSCT patients often died from treatment-related complications (60, 68, and 81%) compared to disease-related (40, 32, and 19%) [4,6,8].…”