Department of Medicine, Sinai Health System, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Intensive-Resucitation Medicine, APHP, Hôpital Saint-Louis, Paris Diderot Sorbonne Université, Paris, France.
Transplant Cell Ther. 2021 Jan;27(1):78.e1-78.e6. doi: 10.1016/j.bbmt.2020.09.035. Epub 2020 Oct 2.
Patients with allogeneic hematopoietic cell transplantation (HCT) who develop acute respiratory failure (ARF) are perceived to have worse outcomes than autologous HCT recipients and non-transplant patients with hematologic malignancy (HM). Within a large international prospective cohort, we evaluated clinical outcomes in these 3 populations. We conducted a secondary analysis of the EFRAIM study, a multicenter observational study of immunocompromised adults with ARF admitted to 62 intensive care units (ICUs) in 16 countries. We described characteristics and compared outcomes of patients with HM who did not undergo transplantation and patients who underwent autologous or allogeneic HCT using multivariable logistic regression and propensity score-matched analyses. A total of 801 patients were included: 570 who did not undergo transplantation, 86 autologous HCT recipients and 145 allogeneic HCT recipients. Acute myelogenous leukemia (171 of 570; 30%) was the most common HM and most common indication for allogeneic HCT (76 of 145; 52%). Compared with the patients who did not undergo HCT and autologous HCT recipients, allogeneic HCT recipients were younger, had fewer comorbid conditions, and were more likely to undergo diagnostic bronchoscopy in the ICU. Unadjusted ICU and hospital mortality were 35% and 45%, respectively, across the entire cohort. In multivariable regression analysis, autologous HCT (odds ratio [OR], 1.07; 95% confidence interval [CI], .57 to 2.03; P = .82) and allogeneic HCT (OR, .99; 95% CI, .60 to 1.66; P = .98) were not associated with higher hospital mortality compared with the no-HCT cohort, adjusting for demographic, functional, clinical, malignancy, and ARF characteristics. The results were similar when analyzed using propensity score-matching techniques. Our findings indicate that autologous and allogeneic HCT recipients who develop ARF and require ICU admission have similar hospital mortality as patients with HM not treated with HCT.
接受异基因造血细胞移植（HCT）的急性呼吸衰竭（ARF）患者比接受自体 HCT 治疗的患者和非移植血液恶性肿瘤（HM）患者预后更差。在一个大型国际前瞻性队列中，我们评估了这 3 个群体的临床结局。我们对 EFRAIM 研究进行了二次分析，该研究是一项多中心观察性研究，纳入了来自 16 个国家的 62 个重症监护病房（ICU）的免疫功能低下的 ARF 成人患者。我们使用多变量逻辑回归和倾向评分匹配分析描述了未接受移植的 HM 患者和接受自体或异基因 HCT 的患者的特征，并比较了这些患者的结局。共纳入 801 例患者：570 例未接受移植、86 例自体 HCT 患者和 145 例异基因 HCT 患者。急性髓细胞白血病（570 例患者中的 171 例；30%）是最常见的 HM，也是异基因 HCT 的最常见适应证（145 例患者中的 76 例；52%）。与未接受 HCT 和自体 HCT 治疗的患者相比，异基因 HCT 患者更年轻，合并症更少，在 ICU 中更有可能进行诊断性支气管镜检查。整个队列的 ICU 和住院死亡率分别为 35%和 45%。在多变量回归分析中，自体 HCT（比值比 [OR]，1.07；95%置信区间 [CI]，.57 至 2.03；P=0.82）和异基因 HCT（OR，.99；95% CI，.60 至 1.66；P=0.98）与未接受 HCT 治疗的患者相比，并未导致更高的住院死亡率，调整了人口统计学、功能、临床、恶性肿瘤和 ARF 特征。使用倾向评分匹配技术进行分析时，结果相似。我们的研究结果表明，发生 ARF 并需要 ICU 入住的自体和异基因 HCT 患者的住院死亡率与未接受 HCT 治疗的 HM 患者相似。
