Risk Factors for Admission to the Intensive Care Unit and Mortality in Allogeneic Hematopoietic Cell Transplant Recipients with Acute Myeloid Leukemia.

BACKGROUND: Adults with acute myeloid leukemia (AML) are at risk of requiring intensive care unit (ICU)-level care following allogeneic hematopoietic cell transplantation (HCT). Risk factors for admission to the ICU and outcomes are, however, poorly defined.

OBJECTIVE: To assess risk factors associated with ICU admission in such patients, identify variables associated with ICU mortality, and analyze the outcome of ICU survivors in comparison to HCT recipients not admitted to the ICU.

STUDY DESIGN: Here, we retrospectively analyzed a cohort of 1,265 adults with MDS/AML or AML who received an allograft while in first or second remission between 2006 and 2023.

RESULTS: The cumulative incidence of ICU admission was 9.2% on day +100 after HCT. HCT-comorbidity index (hazard ratio [HR]=1.15, P=0.005), treatment-related mortality (TRM) score (HR=1.07, P=0.004), and graft from an HLA-mismatched donor (HR=2.19, P=0.018) were independently associated with ICU admission. Within 100 days of ICU admission, 50 patients (43%) died; poor performance status (odds ratio [OR]=5.45, P=0.005), higher TRM score (OR per one unit increase=1.14, P=0.035), and secondary AML (OR=2.71 P=0.035) were associated with increased day +100 mortality after ICU admission. In a landmark analysis, patients admitted to the ICU during the first 100 days after HCT and alive at day +150 had significantly higher NRM (HR=2.36, P<0.001) after multivariable adjustment.

CONCLUSION: Together, these results highlight that ICU admission is common after allografting in adults with AML and is associated with high mortality. Identification of patients at increased risk may, ultimately, help develop possible preventive strategies and allow testing in particularly vulnerable individuals.