Outcome of Children Requiring Intensive Care Following Hematopoietic Stem Cell Transplantation: A Single Center Experience

Abstract

Hematopoietic stem cell transplant (HSCT) is associated with some complications requiring advanced support in the pediatric intensive care unit (PICU). However, the outcome of children requiring admission to a PICU following HSCT in middle-income countries (MICs) are limited. One hundred and four children undergoing hematopoietic stem cell transplantation at a bone marrow transplant service in Colombia from January 2012 to June 2019 were enrolled. Baseline characteristics and clinical courses were described. In addition, we compared some characteristics of patients who survived or died in the PICU through a bivariate analysis. Twenty five PICU admissions were reported. Sixty-four percent survived to be discharged from any PICU admission. Immunodeficiency was the most common underlying disease among patients admitted to the PICU (33%). Respiratory problems (12/25, 48%), and cardiovascular instability (10/25, 40%) were the most common reasons for admission. Cardiovascular support was the most common PICU treatment (21/25, 84%), followed by respiratory support (18/25, 72%). We found that children who require admission to PICU after an allogeneic hematopoietic stem-cell transplantation (Allo-HSCT) present a high mortality rate. Invasive respiratory support, higher vasoactive-inotropic score, renal replacement therapy, and the presence of multi-organ failure were associated with mortality.

Keywords

critical care outcomes / hematopoietic stem cell transplantation / mechanical ventilation / mortality / pediatric intensive care unit / pediatrics

References

[1] A. S. Kanate, N. S. Majhail, B. N. Savani, et al., “Indications for Hematopoietic Cell Transplantation and Immune Effector Cell Therapy: Guidelines From the American Society for Transplantation and Cellular Therapy,” Biology of Blood and Marrow Transplantation 26, no. 7 (2020): 1247–1256.

[2] R. S. Chima, R. C. Daniels, M.-O. Kim, et al., “Improved Outcomes for Stem Cell Transplant Recipients Requiring Pediatric Intensive Care,” Pediatric Critical Care Medicine 13, no. 6 (2012): e336–e342.

[3] S. Gupta, M. Steiner, and J. Hume, “Historical Outcomes of Pediatric Hematopoietic Stem Cell Transplantation Patients Requiring Critical Care,” Journal of Pediatric Intensive Care 3, no. 3 (2015): 083–090.

[4] Z. Szmit, M. Kośmider-Żurawska, A. Król, et al., “Factors Affecting Survival in Children Requiring Intensive Care After Hematopoietic Stem Cell Transplantation. A Retrospective Single-Center Study,” Pediatric Transplantation 24, no. 5 (2020): e13765.

[5] C. Torrecilla, J. L. Cortés, C. Chamorro, J. J. Rubio, P. Galdos, and E. Dominguez de Villota, “Prognostic Assessment of the Acute Complications of Bone Marrow Transplantation Requiring Intensive Therapy,” Intensive Care Medicine 14, no. 4 (1988): 393–398.

[6] D. Schneider, P. Lemburg, I. Sprock, R. Heying, U. Göbel, and W. Nürnberger, “Introduction of the Oncological Pediatric Risk of Mortality Score (O-PRISM) for ICU Support Following Stem Cell Transplantation in Children,” Bone Marrow Transplantation 25, no. 10 (2000): 1079–1086.

[7] J. J. Wong, S. Liu, H. Dang, et al., “The Impact of High Frequency Oscillatory Ventilation on Mortality in Paediatric Acute Respiratory Distress Syndrome,” Critical Care 24, no. 1 (2020): 31.

[8] N. Ravikumar, J. Sankar, and R. R. Das, “Functional Outcomes in Survivors of Pediatric Sepsis: A Scoping Review and Discussion of Implications for Low- and Middle-Income Countries,” Frontiers in Pediatrics 10 (2022): 762179.

[9] G. Cortina, R. McRae, M. Hoq, et al., “Mortality of Critically Ill Children Requiring Continuous Renal Replacement Therapy: Effect of Fluid Overload, Underlying Disease, and Timing of Initiation,” Pediatric Critical Care Medicine 20, no. 4 (2019): 314–322.

[10] L. Elbahlawan, J. Bissler, and R. R. Morrison, “Continuous Renal Replacement Therapy: A Review of Use and Application in Pediatric Hematopoietic Stem Cell Transplant Recipients,” Frontiers in Oncology 11 (2021): 632263.

[11] R. S. Watson, S. S. Crow, M. E. Hartman, J. Lacroix, and F. O. Odetola, “Epidemiology and Outcomes of Pediatric Multiple Organ Dysfunction Syndrome,” Pediatric Critical Care Medicine 18, no. 3 (2017): S4–S16.

[12] M. S. Zinter, B. R. Logan, C. Fretham, et al., “Comprehensive Prognostication in Critically Ill Pediatric Hematopoietic Cell Transplant Patients: Results From Merging the Center for International Blood and Marrow Transplant Research (CIBMTR) and Virtual Pediatric Systems (VPS) Registries,” Biology of Blood and Marrow Transplantation 26, no. 2 (2020): 333–342.

[13] M. Pillon, A. Amigoni, A. Contin, et al., “Risk Factors and Outcomes Related to Pediatric Intensive Care Unit Admission After Hematopoietic Stem Cell Transplantation: A Single-Center Experience,” Biology of Blood and Marrow Transplantation 23, no. 8 (2017): 1335–1341.

[14] K. An, Y. Wang, B. Li, et al., “Prognostic Factors and Outcome of Patients Undergoing Hematopoietic Stem Cell Transplantation Who Are Admitted to Pediatric Intensive Care Unit,” BMC Pediatrics 16, no. 1 (2016): 138.

[15] M. S. Zinter, C. C. Dvorak, A. Spicer, M. J. Cowan, and A. Sapru, “New Insights Into Multicenter PICU Mortality Among Pediatric Hematopoietic Stem Cell Transplant Patients,” Critical Care Medicine 43, no. 9 (2015): 1986–1994.

[16] F. Aspesberro, K. A. Guthrie, A. E. Woolfrey, T. V. Brogan, and J. S. Roberts, “Outcome of Pediatric Hematopoietic Stem Cell Transplant Recipients Requiring Mechanical Ventilation,” Journal of Intensive Care Medicine 29, no. 1 (2014): 31–37.

[17] T. S. Cole, I. C. Johnstone, M. S. Pearce, et al., “Outcome of Children Requiring Intensive Care Following Haematopoietic SCT for Primary Immunodeficiency and Other Non-Malignant Disorders,” Bone Marrow Transplantation 47, no. 1 (2012): 40–45.

[18] M. Eikenberry, H. Bartakova, T. Defor, et al., “Natural History of Pulmonary Complications in Children After Bone Marrow Transplantation,” Biology of Blood and Marrow Transplantation 11, no. 1 (2005): 56–64.

[19] L. M. Ball, “Intensive Care and Outcome in Children Undergoing Haematopoietic Stem Cell Transplantation,” Reports of Practical Oncology and Radiotherapy 12, no. 3 (2007): 171–174.

[20] N. E. Hassan, A. S. Mageed, D. J. Sanfilippo, D. Reischman, U. A. Duffner, and S. Rajasekaran, “Risk Factors Associated With Pediatric Intensive Care Unit Admission and Mortality After Pediatric Stem Cell Transplant: Possible Role of Renal Involvement,” World Journal of Pediatrics 9, no. 2 (2013): 140–145.

[21] K. Gilli, M. Remberger, H. Hjelmqvist, O. Ringden, and J. Mattsson, “Sequential Organ Failure Assessment Predicts the Outcome of SCT Recipients Admitted to Intensive Care Unit,” Bone Marrow Transplantation 45, no. 4 (2010): 682–688.

[22] C. M. Rowan, L. S. Smith, A. Loomis, et al., “Pediatric Acute Respiratory Distress Syndrome in Pediatric Allogeneic Hematopoietic Stem Cell Transplants: A Multicenter Study,” Pediatric Critical Care Medicine 18, no. 4 (2017): 304–309.

[23] J. V. DiCarlo, S. R. Alexander, R. Agarwal, and J. D. Schiffman, “Continuous Veno-Venous Hemofiltration May Improve Survival From Acute Respiratory Distress Syndrome After Bone Marrow Transplantation or Chemotherapy,” Journal of Pediatric Hematology 25, no. 10 (2003): 801–805.

[24] M. Tomaske, A. Bosk, M. Eyrich, P. Bader, and D. Niethammer, “Risks of Mortality in Children Admitted to the Paediatric Intensive Care Unit After Haematopoietic Stem Cell Transplantation,” British Journal of Haematology 121, no. 6 (2003): 886–891.

[25] R. F. Tamburro, R. C. Barfield, M. L. Shaffer, et al., “Changes in Outcomes (1996–2004) for Pediatric Oncology and Hematopoietic Stem Cell Transplant Patients Requiring Invasive Mechanical Ventilation,” Pediatric Critical Care Medicine 9, no. 3 (2008): 270–277.

[26] S. J. Jacobe, A. Hassan, P. Veys, and Q. Mok, “Outcome of Children Requiring Admission to an Intensive Care Unit After Bone Marrow Transplantation,” Critical Care Medicine 31, no. 5 (2003): 1299–1305.

RIGHTS & PERMISSIONS

2025 The Author(s). Pediatric Discovery published by John Wiley & Sons Australia, Ltd on behalf of Children's Hospital of Chongqing Medical University.