Abstract Topic: 30. Infections in hematology (incl. supportive care/therapy)
Background: The prognosis of patients (pts) with hematological malignancies (HM) that develop a hemodynamic shock (HS) following treatment, requiring treatment with vasoactive agents, is considered to be relatively poor. However, limited data exist on pts that were treated during the last decade, especially for those treated outside intensive care unit (ICU), in the hemato-oncological department.
Aims: Our study evaluated the characteristics, outcome and risk factors for death, in hemato-oncological pts that developed HS, treated with vasoactive agents in a single hematological department.
Methods: All consecutive pts fulfilling the following criteria were included: (i) age≥ 18 years (ii) known HM (iii) admitted to the Hematology department at Tel-Aviv Sourasky Medical Center between 01/2017 and 07/2022 (iv) Diagnosed with HS and treated with vasoactive agents. Medical records were extracted using MD-Clone platform ( https://www.mdclone.com ). Data on demographics, HM, most recent anti-neoplastic treatment, cause and treatment of HS (including ventilation support), APACHE II and SOFA scores at initiation of vasoactive agent and 30 day mortality rate were recorded. Analysis for factors predicting survival were performed
Results: One hundred fifty five out of 1641 pts, admitted to the Hematology department, developed post therapy HS. Table 1 present pts characteristics and outcomes. Median age was 66 years (19-85). The most common HMs were acute leukemia (AL) (42%), followed by lymphoproliferative diseases (41%) and multiple myeloma (MM) (16%). Prior to the development of HS, 47% were treated with allogeneic hematopoietic cell transplantation (Allot), 32% had chemotherapy and 20% received immunotherapy (CART or BITE). At the time of HS median APACHE II and SOFA scores were 20 and 7 respectively. Most pts (71%) developed septic shock, 51% with confirmed bacteremia and 19% had cytokine release syndrome (CRS). Forty-five percent (n=69) required respiratory support, 11% having mechanical ventilation. 30 day mortality rate in the entire cohort was 32%; 38%% in sepsis-induced HS and 7% in CRS-induced shock. Diagnosis of AL, prior non immunotherapy based treatment, refractory HM, septic vs CRS-induced HS, need for mechanical ventilation and high APACHE II and SOFA scores were associated with higher 30 day mortality rates.
Summary/Conclusion: Most HM pts that develop post treatment HS are still salvageable and can be treated in hemato-oncological units by experienced hemato-oncology teams. Moreover, CRS-induced HS is almost always reversible and associated with good outcome, whereas septic shock is associated with a poorer survival, especially in patients with active HM and in those requiring mechanical ventilation. APACHE II and SOFA scores can reliably predict survival in patients with non- CRS induced shock.
Keywords: Immunotherapy, Sepsis, Real world data, Infection