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The Impact of Neutrophil Engraftment on the Survival of Intubated Pediatric HCT Patients: A Pediatric Acute Lung Injury and Sepsis Network Study

Year: 2016

Type: article

Abstract: We investigated the role of neutrophil engraftment on survival of pediatric patients who received invasive ventilation for acute respiratory failure following hematopoietic cell transplant (HCT). This is a retrospective cohort study of allogeneic HCT recipients intubated for acute respiratory failure between January 1, 2009 and December 31, 2014. Patients were less 21 years at the time of HCT. All indications for HCT, stem cell source, donor type, and conditioning regimens were included. Institutions contributed the most recent, consecutive 25 patients who received mechanical ventilation during the study period. Patients intubated for surgical procedures were excluded. 128 children from 12 centers were intubated within the first 60 days after HCT (median of 21 days;range 0-59). Acute respiratory failure was the primary indication for ICU admission occurring in 86.7% of patients. 41% of patients (n=53) had not achieved neutrophil engraftment at the time of intubation. The median time of transfer to the ICU for the non-engrafted group was 11 days. Neutrophil engraftment was subsequently achieved in 49% of patients at a median of 17 days (range 6-51). There was a 61.5% ICU survival for patients who achieved neutrophil engraftment post-intubation. Among that group, survivors were younger (median: 1.94 years [range: 0.17-19.78]) than non-survivors (median: 14.67 years [range: 0.33-20.78]. Increased average oxygenation index (OI) and need for vasopressor therapy was noted at the time of neutrophil recovery followed by gradual improvement over the following 24-72 hours. Overall survival to ICU discharge of engrafted and non-engrafted patients was 42%. There was no difference in ICU survival between patients engrafted and those not engrafted at the time of intubation (p=0.86). Mechanical ventilation plays a potentially life-saving role in the care of pediatric HCT recipients. Intubation prior to achievement of neutrophil recovery is not associated with poorer outcome.Table 1Not engrafted at time of intubationN=53Engrafted on ventilator &survivedn=16Engrafted on ventilator & Died n=10Failed to Engraft & Survived n=6Failed to Engraft & Diedn=21Age (years)7.57 (0.15-20.78)1.94 (0.17-19.78)14.67 (0.33-20.78)13.16 (0.15-19.39)5.73 (0.46-18.69)Sex-female45.3%50%60%33.3%38.1%RaceCaucasianAfrican AmericanAsianUnknownOther75.5%5.7%3.8%1.9%13.2%75%12.5%6.25%6.25 %70%30%83.33%16.66%76.2%9.5%14.3%Transplant SourceUnrelated MarrowUCBRelated MarrowPBSC41.5%47.2%7.5%3.8%50%43.8%6.25%60%30%10%66.7%16.7%16.7%38.1%52.4%9.5%DiagnosisALLAMLHLHImmunodeficiencyBone Marrow FailureLymphomaMetabolic DisorderOsteopetrosisOther22.6%17%15.1%13.2%11.3%3.8%9.4%3.8%3.8%31.3%6.3%12.5%18.6%6.3%6.3%12.5%6.3%30%50%10%10%16.7%33.3%33.3%16.7%14.3%4.8%23.8%9.5%23.8%9.5%9.5%4.8% Open table in a new tab

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2015.11.353