Intensive care risk and long-term outcomes in pediatric allogeneic hematopoietic cell transplant recipients

• Published in: Blood advances 2024-02, Vol.8 (4), p.1002-1017
• Main Authors: Zinter, Matt S., Brazauskas, Ruta, Strom, Joelle, Chen, Stella, Bo-Subait, Stephanie, Sharma, Akshay, Beitinjaneh, Amer, Dimitrova, Dimana, Guilcher, Greg, Preussler, Jaime, Myers, Kasiani, Bhatt, Neel S., Ringden, Olle, Hematti, Peiman, Hayashi, Robert J., Patel, Sagar, De Oliveira, Satiro Nakamura, Rotz, Seth, Badawy, Sherif M., Nishihori, Taiga, Buchbinder, David, Hamilton, Betty, Savani, Bipin, Schoemans, Hélène, Sorror, Mohamed, Winestone, Lena, Duncan, Christine, Phelan, Rachel, Dvorak, Christopher C.
• Format: Article
• Language: English
• Subjects: Child; Critical Care; Graft vs Host Disease - epidemiology; Graft vs Host Disease - etiology; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Medicin och hälsovetenskap; Transplant Recipients; Transplantation; Transplantation, Homologous - adverse effects; United States
• ISSN: 2473-9529; 2473-9537; 2473-9537
• DOI: 10.1182/bloodadvances.2023011002

•Among 1067 critically ill pediatric patients with HCT, survival to ICU discharge was 85%, but half of patients required ICU readmission.•For pediatric patients with HCT, overall survival 1-year after ICU admission was only 52% and survivors had excess long-term mortality risk. [Display omitted] 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 intensive care unit (ICU) use 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 6995 pediatric patients with HCT aged ≤21 years who underwent first allogeneic HCT between 2008 and 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 after HCT), and was linked to demographic background, pretransplant 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 pretransplant 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