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ABSTRACT BACKGROUND: Hematopoietic stem cell transplantation (HSCT) recipients requiring intensive care unit (ICU) admission early after transplantation have a poor prognosis. However, many studies have only focused on allogeneic HSCT recipients. OBJECTIVES: To describe the characteristics of HSCT recipients admitted to the ICU shortly after transplantation and assess differences in 1-year mortality between autologous and allogeneic HSCT recipients. DESIGN AND SETTING: A single-center retrospective cohort study in a cancer center in Brazil. METHODS: We included all consecutive patients who underwent HSCT less than a year before ICU admission between 2009 and 2018. We collected clinical and demographic data and assessed the 1-year mortality of all patients. The effect of allogeneic HSCT compared with autologous HSCT on 1-year mortality risk was evaluated in an unadjusted model and an adjusted Cox proportional hazard model for age and Sequential Organ Failure Assessment (SOFA) at admission. RESULTS: Of the 942 patients who underwent HSCT during the study period, 83 (8.8%) were included in the study (autologous HSCT = 57 [68.7%], allogeneic HSCT = 26 [31.3%]). At 1 year after ICU admission, 21 (36.8%) and 18 (69.2%) patients who underwent autologous and allogeneic HSCT, respectively, had died. Allogeneic HSCT was associated with increased 1-year mortality (unadjusted hazard ratio, HR = 2.79 [confidence interval, CI, 95%, 1.48-5.26]; adjusted HR = 2.62 [CI 95%, 1.29-5.31]). CONCLUSION: Allogeneic HSCT recipients admitted to the ICU had higher short- and long-term mortality rates than autologous HSCT recipients, even after adjusting for age and severity at ICU admission.

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BACKGROUND: Hematopoietic stem cell transplantation (HSCT) recipients requiring intensive care unit (ICU) admission early after transplantation have a poor prognosis. However, many studies have only focused on allogeneic HSCT recipients. OBJECTIVES: To describe the characteristics of HSCT recipients admitted to the ICU shortly after transplantation and assess differences in 1-year mortality between autologous and allogeneic HSCT recipients. DESIGN AND SETTING: A single-center retrospective cohort study in a cancer center in Brazil. METHODS: We included all consecutive patients who underwent HSCT less than a year before ICU admission between 2009 and 2018. We collected clinical and demographic data and assessed the 1-year mortality of all patients. The effect of allogeneic HSCT compared with autologous HSCT on 1-year mortality risk was evaluated in an unadjusted model and an adjusted Cox proportional hazard model for age and Sequential Organ Failure Assessment (SOFA) at admission. RESULTS: Of the 942 patients who underwent HSCT during the study period, 83 (8.8%) were included in the study (autologous HSCT = 57 [68.7%], allogeneic HSCT = 26 [31.3%]). At 1 year after ICU admission, 21 (36.8%) and 18 (69.2%) patients who underwent autologous and allogeneic HSCT, respectively, had died. Allogeneic HSCT was associated with increased 1-year mortality (unadjusted hazard ratio, HR = 2.79 [confidence interval, CI, 95%, 1.48-5.26]; adjusted HR = 2.62 [CI 95%, 1.29-5.31]). CONCLUSION: Allogeneic HSCT recipients admitted to the ICU had higher short- and long-term mortality rates than autologous HSCT recipients, even after adjusting for age and severity at ICU admission.

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O Transplante de Medula Óssea (TMO) é um tratamento potencialmente curativo para doenças hematológicas e de alguns tumores sólidos. Os pacientes submetidos a TMO que são admitidos na UTI apresentam altas taxas de mortalidade nos curto e longo prazos. No entanto, devido a melhoras nos cuidados destes pacientes, os resultados têm sido progressivamente melhores. O presente estudo tem o objetivo de descrever a sobrevida global, hospitalar e em 1 ano dos pacientes submetidos à TMO e que foram internados na UTI, comparar a sobrevida em 1 ano de pacientes submetidos ao transplante autólogo e ao transplante alogênico. Nós realizamos um estudo de coorte retrospectiva, com os pacientes submetidos a TMO admitidos à UTI do A.C. Camargo Câncer Center, no período de setembro de 2009 a dezembro de 2018. Foram incluídos pacientes acima de 18 anos que internaram na UTI no prazo de até 1 ano após a realização do transplante de medula óssea. Caso o paciente apresentasse mais de uma passagem pela UTI, somente a primeira foi considerada para análise. Realizamos um modelo de regressão de Cox para avaliar o impacto do tipo de TMO na sobrevida de 1 ano, sem e com ajuste para a idade do paciente. Durante o período de estudo, foram realizados 942 TMO. Houve 117 (12,4%) admissões à UTI de pacientes com menos de 1 ano do TMO. Um total 83 pacientes foram incluídos no estudo, sendo 57 (68,7%) submetidos a TMO autólogo e 26 (31.3%) a TMO alogênico. A mortalidade na UTI foi de 38,5% (n=10) no grupo de TMO alogênico e 12,3% (n=7) de TMO autólogo (p<0,01). Mortalidade hospitalar também foi maior para o grupo alogênico (n=15, 57,7%) versus (n=12, 21,1%) no autólogo (p<0,01). A mediana de sobrevida dos pacientes após a admissão na UTI foi de 400 (IC 95% 133 ­ 1476) dias. Mediana de sobrevida após a admissão na UTI foi de 50,5 (IC 95%, 20 ­ 430) dias para receptores de TMOalogênico e 1115 (IC 95%, 337 ­ NA) dias para receptores de TMO autólogo. O TMO alogênico foi associado a um aumento de mortalidade em um ano quando comparado com o TMO autólogo, tanto no modelo não ajustado [HR = 2.79 (IC=95%, 1.48-5.26)] quanto no modelo ajustado para a idade e score SOFA [HR ajustado = 2.62 (IC95%, 1.29-5.31)].

Hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for many hematological malignancies and some solid tumors. HSCT recipients who require intensive care unit (ICU) admission have high mortality rates. However, due to improvements in the care of these patients, the results have been progressively better. The present study aims to describe the overall, hospital and 1-year survival of HSCT recipients who were admitted to the ICU, comparing the 1-year survival of autologous transplantation and allogeneic transplantation. We performed a retrospective cohort study with HSCT recipients patients admitted to the AC Camargo Cancer Center's ICU from September 2009 to December 2018. Patients 18 years and older who were admitted to the ICU within 1 year after the HSCT was included. If the patient had more than one visit to the ICU, only the first one was considered for analysis. We did a Cox regression model to assess the impact of HSCT type on 1-year survival, with and without adjustment for age. During the study period, there were 942 HSCT in our center. There were 117 (12.4%) admissions to the ICU. 83 patients were included in the study, 57 (68.7%) autologous HSCT and 26 (31.3%) allogeneic HSCT. Mortality in the ICU was 38.5% (n=10) for allogenic HSCT recipients and 12.3% (n=7) for autologous HSCT recipients (p<0.01). Hospital mortality was also higher for allogeneic HSCT recipients (n=15, 57.7%) compared to (n=12, 21.1%) autologous HSCT recipients (p<0.01). The median survival of patients after admission to the ICU was of 400 (95% CI 133 ­ 1476) days. Median survival after admission to the ICU was of 50.5 (95% CI, 20 ­ 430) days for allogeneic HSCT recipients and 1115 (95% CI, 337 ­ NA) days for autologous HSCT recipients. Allogeneic HSCT was associated with increased mortality at one year when compared to autologous HSCT, both in the unadjusted model [HR = 2.79 (CI=95%, 1.48-5.26)] and in the age and SOFA scoreadjusted model [HR-adjusted = 2.62 (95%CI, 1.29-5.31)].

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