Intensive care outcomes in adult hematopoietic stem cell transplantation patients

Bayraktar, Ulas D.; Nates, Joseph L.

doi:10.5306/wjco.v7.i1.98

Cited by 37 publications

(34 citation statements)

References 39 publications

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“…(GVHD), infections, and liver, kidney, and lung damages have been reported through the last decade [8]. However, allo-HSCT remains associated with significant mortality with 10-50% of patients requiring intensive care unit (ICU) management for a life-threatening complication [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Critically ill allogenic HSCT patients in the intensive care unit: a systematic review and meta-analysis of prognostic factors of mortality

Saillard

Darmon

Bisbal

et al. 2018

Bone Marrow Transplant

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Outcome of patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT) has improved. To investigate if this improvement can be transposed to the ICU setting, we conducted a systematic review and meta-analysis to assess short-term mortality of critically ill allo-HSCT patients admitted to the ICU and to identify prognostic factors of mortality. Public-domain electronic databases, including Medline via PubMed and the Cochrane Library were searched. All full-text articles written-English studies published from 2006 to 2016, including allo-HSCT adults transferred to the ICU were included. Eighteen studies were selected, including 2342 patients. Overall estimated ICU mortality was 51.7%. Prognostic factors associated with an increased ICU mortality were mechanical ventilation (OR = 12.2, 95% CI = 6.2-23.7), vasopressors (OR = 6.3, 95% CI = 3.6-11.1), renal replacement therapy (OR = 4.2, 95% CI = 2.8-6.2), ICU admission for acute respiratory failure (OR = 2.2, 95% CI = 1.1-4.4), acute kidney injury (OR = 2.2, 95% CI = 1.3-4), and acute graft-versus-host disease (OR = 1.6, 95% CI = 1.1-2.3). Factors associated with an increased ICU survival were a single-organ failure (OR = 0.2, 95% CI = 0.1-0.4), neurological failure (OR = 0.4, 95% CI = 0.2-0.8), and reduced-intensity conditioning regimens (OR = 0.7, 95% CI = 0.5-0.9). Septic shock, underlying malignancy, disease status, donor, and graft source did not impact prognosis. Outcome has improved, supporting the usefulness of ICU management. Organ failures at ICU admission, organ support requirement, and GVHD are the main prognostic factors.

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Section: Introductionmentioning

confidence: 99%

Critically ill allogenic HSCT patients in the intensive care unit: a systematic review and meta-analysis of prognostic factors of mortality

Saillard

Darmon

Bisbal

et al. 2018

Bone Marrow Transplant

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“…The longer the grafting time, the higher is the risk of infections and other complications that can lead to death 19 . The positive correlations between DI and NOx with grafting time, as well as the negative correlation with Gpx, indicate the potential of these biomarkers as predictors of toxicity and grafting time in autologous HSCT in MM and Lymphomas.…”

Section: Discussionmentioning

confidence: 99%

Association of oxidative stress and DNA damage with grafting time in patients with multiple myeloma and lymphoma submitted to autologous hematopoietic stem cell transplantation

Duarte

Filho

Santos

et al. 2016

Rev. Assoc. Med. Bras.

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The aim of the study was to investigate the association between oxidative stress and DNA damage with grafting time in patients submitted to autologous hematopoietic stem-cell transplantation (HSCT). The study included 37 patients submitted to autologous HSCT diagnosed with Multiple Myeloma (MM) and lymphoma (Hodgkin’s and non-Hodgkin’s). Biomarkers of oxidative stress and DNA damage index (DI) were performed at baseline (pre-CR) of the disease and during the conditioning regimen (CR), one day after the HSCT, ten days after HSCT and twenty days after HSCT, as well as in the control group consisting of 30 healthy individuals. The outcomes showed that both groups of patients had an hyperoxidative state with high DI when compared to baseline and to the control group and that the CR exacerbated this condition. However, after the follow-up period of the study, this picture was re-established to the baseline levels of each pathology. The study patients with MM showed a mean grafting time of 10.75 days (8 to 13 days), with 10.15 days (8 to 15 days) for the lymphoma patients. In patients with MM, there was a negative correlation between the grafting time and the basal levels of GPx (r = -0.54; p = 0.034), indicating that lower levels of this important enzyme are associated with a longer grafting time. For the DI, the correlation was a positive one (r = 0.529; p = 0.030). In the group with lymphoma, it was observed that the basal levels of NOx were positively correlated with grafting time (r = 0.4664, p = 0.032). The data indicate the potential of these biomarkers as predictors of toxicity and grafting time in patients with MM and Lymphomas submitted to autologous HSCT.

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“…There are 2 types of transplants: autologous, where the patient's own stem cells are transplanted, and allogenic, where stem cells are transplanted from a histocompatible donor 65 . ICU admission following HSCT has been reported among 9%–20% of patients receiving these forms of treatment and is associated with poor prognosis 66 – 71 …”

Section: Graft Versus Host Diseasementioning

confidence: 99%

“…Pene et al 71 found that patients with active GVHD at the time of ICU admission had worse prognosis than those without active GVHD at time of ICU admission. There is likely a direct relationship between GVHD and ICU mortality, as GVHD damages tissues and the treatment of GVHD consists of immune suppression, which can increase risk for severe infections 66 . The primary focus of this review section is GVHD of the GI tract and the complications associated with feeding this population 72 …”

Section: Graft Versus Host Diseasementioning

confidence: 99%

Nutrition Support for Critically Ill Patients With Cancer

Lach

Peterson

2017

Nut in Clin Prac

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Oncology patients often experience the classic signs of malnutrition-weight loss as well as fat and muscle wasting, which have been associated with poor tolerance to treatment and increased morbidity and mortality. Nutrition status may be an important factor in determining tolerance to treatment and outcomes associated with it. Thus, identification of those with preexisting malnutrition or who are at risk for developing malnutrition is crucial not only at time of cancer diagnosis but also throughout the treatment course so that nutrition interventions may be implemented to prevent development or worsening of malnutrition in this high-risk population. These patients often have extremely complicated hospital courses due to the aggressive nature of the disease and treatment, leading to intensive care unit admission and periods of critical illness. Critical illness is associated with catabolism, extreme stress on the body, and a state of systemic inflammation. During critical illness, it is important to provide adequate nutrition to prevent further break down of lean muscle mass and oxidative cellular injury and to regulate favorable immune responses. The purpose of this review is to discuss the importance of nutrition screening and assessment for the critically ill patient with cancer; to appropriately identify those at risk for, or who have developed, malnutrition; and to provide appropriate interventions to optimize nutrition status. This review also discusses the complications and difficulties associated with feeding this patient population and offers nutrition support recommendations.

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Intensive care outcomes in adult hematopoietic stem cell transplantation patients

Cited by 37 publications

References 39 publications

Critically ill allogenic HSCT patients in the intensive care unit: a systematic review and meta-analysis of prognostic factors of mortality

Critically ill allogenic HSCT patients in the intensive care unit: a systematic review and meta-analysis of prognostic factors of mortality

Association of oxidative stress and DNA damage with grafting time in patients with multiple myeloma and lymphoma submitted to autologous hematopoietic stem cell transplantation

Nutrition Support for Critically Ill Patients With Cancer

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