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

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.