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Post-Transplant Events

Outcome of children requiring intensive care following haematopoietic SCT for primary immunodeficiency and other non-malignant disorders

Abstract

Haematopoietic SCT (HSCT) is curative for many children with primary immunodeficiencies or other non-malignant conditions. Outcome for those admitted to intensive care following HSCT for oncology diagnoses has historically been very poor. There is no literature available specifically regarding the outcome for children with primary immunodeficiency requiring intensive care following HSCT. We reviewed our post-HSCT admission to intensive care over a 5-year period. A total of 111 children underwent HSCT. Median age at transplant was 1 year 4 months. The most common diagnosis was SCID. In all, 35% had at least one intensive care admission and 44% survived to be discharged from intensive care. Also, 73% of admission episodes requiring invasive ventilation but no inotropes or renal replacement therapy resulted in survival to discharge. Children undergoing HSCT for immunological diagnoses had a high rate of admission to intensive care. No factors were identified that could predict the need for admission. Invasive ventilation alone has a much better outcome than that in historical series. However, the need for multi-organ system support was still associated with a poor outcome. This information is useful when counselling families of children that have deteriorated and been admitted to intensive care during the HSCT procedure.

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References

  1. Gennery AR, Cant AJ . Advances in hematopoietic stem cell transplantation for primary immunodeficiency. Immunol Allergy Clin North Am 2008; 28: 439–456.

    Article  PubMed  Google Scholar 

  2. Gennery AR, Slatter MA, Grandin L, Taupin P, Cant AJ, Veys P et al. Transplantation of haematopoietic stem cells and longterm survival for primary immunodeficiencies in Europe: entering a new century, do we do better? J Allergy Clin Immunol 2010; 126: 602–610.

    Article  PubMed  Google Scholar 

  3. Diaz de Heredia C, Moreno A, Olive T, Iglesias J, Ortega JJ . Role of the intensive care unit in children undergoing bone marrow transplantation with life-threatening complications. Bone Marrow Transplant 1999; 24: 163–168.

    Article  CAS  PubMed  Google Scholar 

  4. Torrecilla C, Cortes JL, Chamorro C, Rubio JJ, Galdos P, Dominguez de Villota E . Prognostic assessment of acute complications of bone marrow transplantation requiring intensive therapy. Intensive Care Med 1988; 14: 393–398.

    Article  CAS  PubMed  Google Scholar 

  5. Kache S, Weiss IK, Moore TB . Changing outcomes for children requiring intensive care following hematopoietic stem cell transplantation. Pediatr Transplant 2006; 10: 299–303.

    Article  PubMed  Google Scholar 

  6. Jackson SR, Tweeddale MG, Barnett MJ, Spinelli JJ, Sutherland HJ, Reece DE et al. Admission of bone marrow transplant recipients to the intensive care unit: outcome, survival and prognostic factors. Bone Marrow Transplant 1998; 21: 697–704.

    Article  CAS  PubMed  Google Scholar 

  7. Hayes C, Lush RJ, Cornish JM, Foot AM, Henderson J, Jenkins I et al. The outcome of children requiring admission to an intensive care unit following bone marrow transplantation. Br J Haematol 1998; 102: 666–670.

    Article  CAS  PubMed  Google Scholar 

  8. Naeem N, Reed MD, Creger RJ, Youngner SJ, Lazarus HM . Transfer of the hematopoietic stem cell transplant patient to the intensive care unit: does it really matter? Bone Marrow Transplant 2006; 37: 119–133.

    Article  CAS  PubMed  Google Scholar 

  9. van Gestel J, Bollen C, van der Tweel I, Boelens JJ, van Vught A . Intensive care unit mortality trends in children after hematopoietic stem cell transplantation: a meta-regression analysis. Crit Care Med 2008; 36: 2898–2904.

    Article  PubMed  Google Scholar 

  10. Rossi R, Shemie S, Calderwood S . Prognosis of pediatric bone marrow transplant recipients requiring mechanical ventilation. Crit Care Med 1999; 27: 1181–1186.

    Article  CAS  PubMed  Google Scholar 

  11. Paz HL, Crilley P, Weinar M, Brodsky I . Outcome of patients requiring medical ICU admission following bone marrow transplantation. Chest 1993; 104: 527–531.

    Article  CAS  PubMed  Google Scholar 

  12. Jacobe SJ, Hassan A, Veys P, Mok Q . Outcome of children requiring admission to an intensive care unit after bone marrow transplantation. Crit Care Med 2003; 31: 1299–1305.

    Article  PubMed  Google Scholar 

  13. Faber-Langendoen K, Caplan AL, McGlave PB . Survival of adult bone marrow transplant patients receiving mechanical ventilation: a case for restricted use. Bone Marrow Transplant 1993; 12: 501–507.

    CAS  PubMed  Google Scholar 

  14. Price KJ, Thall PF, Kish SK, Shannon VR, Andersson BS . Prognostic indicators for blood and marrow transplant patients admitted to an intensive care unit. Am J Respir Crit Care Med 1998; 158: 876–884.

    Article  CAS  PubMed  Google Scholar 

  15. Soubani AO, Kseibi E, Bander JJ, Klein JL, Khanchandani G, Ahmed HP et al. Outcome and prognostic factors of hematopoietic stem cell transplantation recipients admitted to a medical ICU. Chest 2004; 126: 1604–1611.

    Article  PubMed  Google Scholar 

  16. Huaringa AJ, Leyva FJ, Giralt SA, Blanco J, Signes-Costa J, Velarde H et al. Outcome of bone marrow transplantation patients requiring mechanical ventilation. Crit Care Med 2000; 28: 1014–1017.

    Article  CAS  PubMed  Google Scholar 

  17. Afessa B, Tefferi A, Hoagland HC, Letendre L, Peters SG . Outcome of recipients of bone marrow transplants who require intensive-care unit support. Mayo Clin Proc 1992; 67: 117–122.

    Article  CAS  PubMed  Google Scholar 

  18. Lamas A, Otheo E, Ros P, Vazquez JL, Maldonado MS, Munoz A et al. Prognosis of child recipients of hematopoietic stem cell transplantation requiring intensive care. Intensive Care Med 2003; 29: 91–96.

    Article  PubMed  Google Scholar 

  19. Hagen SA, Craig DM, Martin PL, Plumer DD, Gentile MA, Schulman SR et al. Mechanically ventilated pediatric stem cell transplant recipients: effect of cord blood transplant and organ dysfunction on outcome. Pediatr Crit Care Med 2003; 4: 206–213.

    Article  PubMed  Google Scholar 

  20. Eikenberry M, Bartakova H, Defr T, Haddad IY, Ramsay NK, Blazar BR et al. Natural history of pulmonary complications in children after bone marrow transplantation. Biol Blood Marrow Transplant 2005; 11: 56–64.

    Article  PubMed  Google Scholar 

  21. Tamburro RF, Barfield RC, Shaffer ML, Rajasekaran S, Woodard P, Morrison RR et al. Changes in outcomes (1996–2004) for pediatric oncology and hematopoietic stem cell transplant patients requiring invasive mechanical ventilation. Pediatr Crit Care Med 2008; 9: 270–277.

    Article  PubMed  Google Scholar 

  22. Gennery AR, Khawaja K, Veys P, Bredius RG, Notarangelo LD, Mazzolari E et al. Treatment of CD40 ligand deficiency by hematopoietic stem cell transplantation: a survey of the European experience, 1993–2002. Blood 2004; 103: 1152–1157.

    Article  CAS  PubMed  Google Scholar 

  23. Keenan HT, Bratton SL, Martin LD, Crawford SW, Weiss NS . Outcome of children who require mechanical ventilatory support after bone marrow transplantation. Crit Care Med 2000; 28: 830–835.

    Article  CAS  PubMed  Google Scholar 

  24. Smoyer WE, McAdams C, Kaplan BS, Sherbotie JR . Determinants of survival in pediatric continuous hemofiltration. J Am Soc Nephrol 1995; 6: 1401–1409.

    CAS  PubMed  Google Scholar 

  25. Hayes LW, Oster RA, Tofil NM, Tolwani AJ . Outcomes of critically ill children requiring continuous renal replacement therapy. J Crit Care 2009; 24: 394–400.

    Article  PubMed  Google Scholar 

  26. Rajasekaran S, Jones DP, Avent Y, Shaffer ML, Elbahlawan L, Henderson N et al. Outcomes of hematopoietic stem cell transplant patients who received continuous renal replacement therapy in a pediatric oncology intensive care unit. Pediatr Crit Care Med 2010; 11: 699–706.

    Article  PubMed  Google Scholar 

  27. Draper E, Lamming C, McKinney P, McShane P, Parslow R, Shearing A et al. Annual Report of the Paediatric Intensive Care Audit Network, January 2007–December 2009. Universities of Leeds and Leicester, 2010.

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Correspondence to M A Slatter.

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Cole, T., Johnstone, I., Pearce, M. et al. Outcome of children requiring intensive care following haematopoietic SCT for primary immunodeficiency and other non-malignant disorders. Bone Marrow Transplant 47, 40–45 (2012). https://doi.org/10.1038/bmt.2011.26

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