Intensive Care Risk and Long-Term Outcomes in Pediatric Allogeneic Hematopoietic Cell Transplant Recipients

Author:

Zinter Matt S1ORCID,Brazauskas Ruta2,Strom Joelle3,Chen Stella4,Bo-Subait Stephanie5,Sharma Akshay6ORCID,Beitinjaneh Amer7,Dimitrova Dimana8ORCID,Guilcher Gregory9,Preussler Jaime M.10ORCID,Myers Kasiani C11ORCID,Bhatt Neel S.12ORCID,Ringden Olle13ORCID,Hematti Peiman14ORCID,Hayashi Robert J.15,Patel Sagar S.16ORCID,De Oliveira Satiro17ORCID,Rotz Seth J.18,Badawy Sherif M19,Nishihori Taiga20ORCID,Buchbinder David K21,Hamilton Betty K.22,Savani Bipin N23ORCID,Schoemans Hélène M.24ORCID,Sorror Mohamed Lotfy25ORCID,Winestone Lena E.26ORCID,Duncan Christine27,Phelan Rachel2,Dvorak Christopher C28ORCID

Affiliation:

1. University of California, San Francisco, San Francisco, California, United States

2. Medical College of Wisconsin, Milwaukee, Wisconsin, United States

3. CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States

4. CIBMTR, Milwaukee, Wisconsin, United States

5. CIBMTR, National Marrow Donor Program/Be the Match, Minneapolis, Minnesota, United States

6. St Jude Children's Research Hospital, Memphis, Tennessee, United States

7. University of Miami Health System, Miami, Florida, United States

8. National Institutes of Health, Bethesda, Maryland, United States

9. Alberta Children's Hospital, Calgary, Alberta, Canada

10. National Marrow Donor Program/Be The Match, Minneapolis, Minnesota, United States

11. Department of Pediatrics, University of Cincinnati College of Medicine; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

12. Fred Hutchinson Cancer Center, Seattle, Washington, United States

13. Karolinska Institutet, Huddinge, Sweden

14. Medical College of Wisconsin, Madison, Wisconsin, United States

15. Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States

16. Huntsman Cancer Institute, Salt Lake City, Utah, United States

17. David Geffen School of Medicine, UCLA, Los Angeles, California, United States

18. Cleveland Clinic Children's Hospital, Cleveland, Ohio, United States

19. Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, United States

20. Moffitt Cancer Center, Tampa, Florida, United States

21. Children's Hospital of Orange County, Orange, California, United States

22. Cleveland Clinic, Cleveland, Ohio, United States

23. Vanderbilt University Medical Center, Nashville, Tennessee, United States

24. University Hospitals Leuven, Leuven, Belgium

25. Fred Hutchinson Cancer Center and the University of Washington School of Medicine, Seattle, Washington, United States

26. University of California San Francisco Benioff Children's Hospitals, San Fransisco, California, United States

27. Dana Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States

28. University of California San Francisco Children's Hospital, San Francisco, California, United States

Abstract

Allogeneic hematopoietic cell transplantation (HCT) can be complicated by life-threatening organ toxicity and infection necessitating intensive care. Epidemiologic data have been limited by single-center studies, poor database granularity, and a lack of long-term survivors. To identify contemporary trends in ICU utilization and long-term outcomes, we merged data from the Center for International Blood and Marrow Transplant Research and the Virtual Pediatric Systems databases. We identified 6,995 pediatric HCT patients age ≤21 years who underwent 1st allogeneic HCT between 2008-2014 across 69 centers in the United States or Canada and followed patients until the year 2020. ICU admission was required for 1067 patients (8.3% by day +100, 12.8% by 1 year, and 15.3% by 5 years post-HCT), and was linked to demographic background, pre-transplant organ toxicity, allograft type and HLA-match, and the development of graft-versus-host disease or malignancy relapse. Survival to ICU discharge was 85.7% but more than half of ICU survivors required ICU readmission, leading to 52.5% and 42.6% survival at 1- and 5-years post-ICU transfer, respectively. ICU survival was worse among patients with malignant disease, poor pre-transplant organ function, and alloreactivity risk-factors. Among 1-year HCT survivors, those who required ICU in the first year had 10% lower survival at 5 years and developed new dialysis-dependent renal failure at a greater rate (p<0.001). Thus, while ICU management is common and survival to ICU discharge is high, ongoing complications necessitate recurrent ICU admission and lead to a poor 1-year outcome in select high-risk patients.-

Publisher

American Society of Hematology

Subject

Hematology

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