Historically, the survival rate in patients with hematologic malignancy who develop acute respiratory failure (ARF) requiring mechanical ventilation (MV) following allogeneic hematopoietic stem cell transplantation (HSCT) has been very poor, ranging from 4-13%. The purpose of this study was to determine if there has been any change in the outcome of this patient population in recent years.
We retrospectively analyzed the outcomes of all ICU patients with hematologic malignancy treated with allogeneic HSCT who developed ARF and/or sepsis with ARF and required MV for ≥ 24 h. The study period was from January 1, 2000 to December 31, 2002. Patients < 18 years of age were excluded. Hospital survival was extubation from MV and discharged alive from the hospital.
46 allogeneic HSCT patients received MV for ≥ 24 h. 27(59%) were male and 19 (41%) were female. Mean age was 40 years (range: 19-67). Indications for HSCT were leukemia (n=28), lymphoma (n= 10), myelodysplastic syndrome (n=7), and Waldenstrom’s macroglobulinemia (n=1). The source of the stem cells was peripheral blood in 24 (52%) and bone marrow in 22 (48%). 34 of the 46 MV patients had documented infection. Ten (22%) of the 46 MV patients survived and 36 (78%) died. The mean age of survivors was 34 yr. However, only 3 (30%) of the 10 MV patients who initially survived were alive at 6 months.CONCLUSIONS: The ICU survival rate of allogeneic HSCT patients who developed ARF and received MV has improved in recent years.
The increased survival rate for MV allogeneic HSCT patients in this series may perhaps be related to advances in ventilator and sepsis management, early shock resuscitation and ICU admission.
S.M. Pastores, None.