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Objective <p>To describe the clinical characteristics and management and to identify factors associated with outcomes of patients requiring intensive care unit (ICU) admission after autologous hematopoietic stem-cell transplantation (ASCT).</p> Design <p>Multicenter retrospective observational cohort study.</p> Setting <p>Eight university-hospital ICUs in France between January 2013 and July 2023.</p> Patients <p>Consecutive adults (≥ 18&#xa0;years) admitted to the ICU within 90&#xa0;days following ASCT conditioning.</p> Interventions <p>None.</p> Measurements and main results <p>Among 6,342 ASCT recipients, 355 (5.6%) required ICU admission. Most had malignant lymphoma (60%) or multiple myeloma (34.6%). Admission typically occurred during the aplastic phase (median, 13&#xa0;days after conditioning). Sepsis was the predominant diagnosis (75.9%), with the most common sources being neutropenic enterocolitis (more common in lymphoma) and pneumonia (more common in myeloma). Vasopressors were required in 181 (51%) patients and invasive mechanical ventilation in 121 (34.1%) patients. ICU mortality was 13.5% (48 patients) and 90-day mortality was 23.9% (85 patients). By multivariable analysis, factors independently associated with 90-day mortality were higher SAPS II score, lower serum albumin, performance status score ≥ 2, and lymphoma as the underlying malignancy. At one year, 209 (58.9%) patients were alive and in remission, including 198 (94.7%) with a good performance status.</p> Conclusions <p>ICU admission was required for 5.6% of patients after ASCT, chiefly during the neutropenic period. Although organ support was often required, good short- and long-term outcomes were obtained, with most survivors achieving a sustained remission and functional recovery. The clinical profiles differed between patients with myeloma and those with lymphoma, and the latter had lower survival.</p>

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Characterization and outcomes of severe complications after autologous hematopoietic stem-cell transplantation: a retrospective multicenter study

  • 期刊论文

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  • 发表日期：

    2026年6月25日

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  • Corentin Le Cacheux,
  • Mathilde Bastien,
  • Aurélie Le Thuaut,
  • Arthur Orieux,
  • Léa Courtot-Melciolle,
  • Muriel Picard,
  • Mathilde Chanut,
  • Frédéric Pène,
  • Guillaume Dumas,
  • Anne-Sophie Moreau,
  • Quentin Quelven,
  • Lara Zafrani,
  • Emmanuel Canet

摘要

Objective

To describe the clinical characteristics and management and to identify factors associated with outcomes of patients requiring intensive care unit (ICU) admission after autologous hematopoietic stem-cell transplantation (ASCT).

Design

Multicenter retrospective observational cohort study.

Setting

Eight university-hospital ICUs in France between January 2013 and July 2023.

Patients

Consecutive adults (≥ 18 years) admitted to the ICU within 90 days following ASCT conditioning.

Interventions

None.

Measurements and main results

Among 6,342 ASCT recipients, 355 (5.6%) required ICU admission. Most had malignant lymphoma (60%) or multiple myeloma (34.6%). Admission typically occurred during the aplastic phase (median, 13 days after conditioning). Sepsis was the predominant diagnosis (75.9%), with the most common sources being neutropenic enterocolitis (more common in lymphoma) and pneumonia (more common in myeloma). Vasopressors were required in 181 (51%) patients and invasive mechanical ventilation in 121 (34.1%) patients. ICU mortality was 13.5% (48 patients) and 90-day mortality was 23.9% (85 patients). By multivariable analysis, factors independently associated with 90-day mortality were higher SAPS II score, lower serum albumin, performance status score ≥ 2, and lymphoma as the underlying malignancy. At one year, 209 (58.9%) patients were alive and in remission, including 198 (94.7%) with a good performance status.

Conclusions

ICU admission was required for 5.6% of patients after ASCT, chiefly during the neutropenic period. Although organ support was often required, good short- and long-term outcomes were obtained, with most survivors achieving a sustained remission and functional recovery. The clinical profiles differed between patients with myeloma and those with lymphoma, and the latter had lower survival.