scholarly journals Risk Factors for Noninvasive Ventilation Failure in Children Post-Hematopoietic Cell Transplant

2021 ◽  
Vol 11 ◽  
Author(s):  
Courtney M. Rowan ◽  
Julie C. Fitzgerald ◽  
Asya Agulnik ◽  
Matt S. Zinter ◽  
Matthew P. Sharron ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Rate ◽  
Noninvasive Ventilation ◽  
Univariate Analysis ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Vasoactive Agent ◽  
Observational Cohort ◽  
Ventilation Failure

RationaleLittle is known on the use of noninvasive ventilation (NIPPV) in pediatric hematopoietic cell transplant (HCT) patients.ObjectiveWe sought to describe the landscape of NIPPV use and to identify risk factors for failure to inform future investigation or quality improvement.MethodsThis is a multicenter, retrospective observational cohort of 153 consecutive children post-HCT requiring NIPPV from 2010-2016.Results97 (63%) failed NIPPV. Factors associated with failure on univariate analysis included: longer oxygen use prior to NIPPV (p=0.04), vasoactive agent use (p<0.001), and higher respiratory rate at multiple hours of NIPPV use (1hr p=0.02, 2hr p=0.04, 4hr p=0.008, 8hr p=0.002). Using respiratory rate at 4 hours a multivariable model was constructed. This model demonstrated high ability to discriminate NIPPV failure (AUC=0.794) with the following results: respiratory rate >40 at 4 hours [aOR=6.3 9(95% CI: 2.4, 16.4), p<0.001] and vasoactive use [aOR=4.9 (95% CI: 1.9, 13.1), p=0.001]. Of note, 11 patients had a cardiac arrest during intubation (11%) and 3 others arrested prior to intubation. These 14 patients were closer to HCT [14 days (IQR:4, 73) vs 54 (IQR:21,117), p<0.01] and there was a trend toward beginning NIPPV outside of the PICU and arrest during/prior to intubation (p=0.056).ConclusionsIn this cohort respiratory rate at 4 hours and vasoactive use are independent risk factors of NIPPV failure. An objective model to predict which children may benefit from a trial of NIPPV, may also inform the timing of both NIPPV initiation and uncomplicated intubation.

scholarly journals Invasive mold infections in allogeneic hematopoietic cell transplant recipients in 2020: have we made enough progress?

2021 ◽  
Author(s):  
Romain Samuel Roth ◽  
Stavroula Masouridi-Levrat ◽  
Yves Chalandon ◽  
Anne-Claire Mamez ◽  
Federica Giannotti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Strategies ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Hematopoietic Cell Transplant ◽  
Allogeneic Hematopoietic Cell Transplant ◽  
Incidence Risk ◽  
One Year ◽  
Invasive Mold Infections

Abstract Background Despite progress in diagnostic, prevention and treatment strategies, invasive mold infections (IMI) remain leading cause of mortality in allogeneic hematopoietic cell transplant recipients (allo-HCT-recipients). Methods We describe the incidence, risk factors, and mortality of allo-HCT-recipients with proven/probable IMI in a retrospective single-center 10-year (01.01.2010-01.01.2020) cohort study. Results Among 515 allo-HCT-recipients, 48 (9.3%) patients developed 51 proven/probable IMI: invasive aspergillosis (IA; 34/51, 67%), mucormycosis (9/51, 18%) and other molds (8/51, 15%). Overall 35/51 (68.6%) breakthrough-IMI (bIMI) were identified: 22/35 (62.8%) IA and 13/35 (37.1%) non-IA IMI. One-year IMI cumulative incidence was 7%: 4.9% and 2.1% for IA and non-IA IMI, respectively. Fourteen (29.2 %), 10 (20.8%), and 24 (50.0%) patients were diagnosed during the first 30, 31-180, and >180 days post-HCT, respectively. Risk factors for IMI included: prior allo-HCT (SHR:4.06, p=0.004) and ≥grade-2 acute graft-versus-host disease (aGvHD; SHR: 3.52, p<0.001). All-cause 1-year mortality was 33% (170/515): 48% (23/48) and 31.5% (147/467) for patients with and without IMI (p=0.02). Mortality predictors included: disease relapse (HR:7.47, p<0.001), aGvHD (HR:1.51, p=0.001), CMV-serology-positive recipients (HR:1.47, p=0.03), and IMI (HR:3.94, p<0.001). All-cause 12-week mortality for patients with IMI was 35.4% (17/48): 31.3% (10/32) for IA and 43.8% (7/16) for non-IA IMI (logrank 0.47). At 1-year post-IMI diagnosis, 70.8% (34/48) of patients were dead. Conclusions IA mortality has remained relatively unchanged during the last two decades. More than two thirds of allo-HCT-recipients with IMI die by 1-year post-IMI diagnosis. Dedicated intensified research efforts are required to further improve clinical outcomes.

scholarly journals Risk Factors for Transplant-Associated Thrombotic Microangiopathy after Autologous Hematopoietic Cell Transplant in High-Risk Neuroblastoma

2019 ◽  
Vol 25 (10) ◽  
pp. 2031-2039 ◽  
Author(s):  
Vanessa P. Tolbert ◽  
Christopher C. Dvorak ◽  
Carla Golden ◽  
Madhav Vissa ◽  
Nura El-Haj ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Thrombotic Microangiopathy ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant

scholarly journals Risk Factors for Musculoskeletal Symptoms in 5-20 Year Survivors Who Received Myeloablative Hematopoietic Cell Transplant (HCT)

2014 ◽  
Vol 20 (2) ◽  
pp. S67
Author(s):  
Jean C. Yi ◽  
Paul Martin ◽  
Barry E. Storer ◽  
Janet R. Abrams ◽  
Samantha B. Artherholt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hematopoietic Cell ◽  
Musculoskeletal Symptoms ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant

scholarly journals Steroid-dependent acute GVHD after allogeneic hematopoietic cell transplantation: risk factors and clinical outcomes

2021 ◽  
Vol 5 (5) ◽  
pp. 1352-1359
Author(s):  
Najla El Jurdi ◽  
Ahmad Rayes ◽  
Margaret L. MacMillan ◽  
Shernan G. Holtan ◽  
Todd E. DeFor ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hematopoietic Cell Transplantation ◽  
Chronic Gvhd ◽  
Hematopoietic Cell ◽  
Unrelated Donor ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Allogeneic Hematopoietic Cell Transplant ◽  
Steroid Dependent ◽  
Steroid Sensitive

Abstract Acute graft-versus-host disease (aGVHD) has various risk factors and outcomes. We defined distinct aGVHD treatment response groups based on response to first-line corticosteroids: steroid sensitive (SS), steroid resistant (SR), and the rarely studied steroid dependent (SD) aGVHD. In 1143 consecutive adult and pediatric allogeneic hematopoietic cell transplant recipients, 385 (34%) developed aGVHD, with 10% having SS aGVHD, 9% SD aGVHD, and 14% SR aGVHD. The only factor significantly associated with SD in comparison with SS was older age (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.4-11.3, when comparing 18- to 60-year-olds with <18-year-olds). Factors significantly associated with SR in comparison with SS were unrelated donor (OR, 3.0; 95% CI, 1.2-7.4) and Minnesota high-risk aGVHD (OR, 2.4; 95% CI, 1.3-4.6). SR aGVHD was independently associated with higher risk for 2-year overall mortality (hazards ratio [HR], 1.8; 95% CI, 1.2-2.8) and nonrelapse mortality (NRM; HR, 2.1; 95% CI, 1.2-3.9). SS and SD GVHD groups had similar overall survival and NRM. The cumulative incidence of chronic GVHD was highest in the SD group, followed by the SR and SS groups (46%, 41%, and 29%, respectively). SD and SS GVHD had similar prognoses, both markedly better than those of the SR groups.

scholarly journals 1163: NONINVASIVE VENTILATION USE PRIOR TO INTUBATION IN PEDIATRIC HEMATOPOIETIC CELL TRANSPLANT PATIENTS

2021 ◽  
Vol 50 (1) ◽  
pp. 580-580
Author(s):  
Daniel Cater ◽  
Julie Fitzgerald ◽  
Shira Gertz ◽  
Jennifer McArthur ◽  
Megan Daniel ◽  
...  
Keyword(s):  
Noninvasive Ventilation ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Transplant Patients

scholarly journals The Impact of Graft-Versus-Host Disease on Survival in Children with Non-Malignant Disorders Receiving Allogeneic Hematopoietic Cell Transplant

2021 ◽  
Author(s):  
Biljana Horn ◽  
Paul Castillo ◽  
Mustafa Hanif ◽  
Jorge GalvezSilva ◽  
Edward Ziga ◽  
...  
Keyword(s):  
Risk Factors ◽  
Graft Versus Host Disease ◽  
Survival Rates ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Host Disease ◽  
Graft Versus Host ◽  
The Impact ◽  
Grade Iii

Abstract Background: Graft-versus-host disease (GVHD) is a common and undesirable complication of hematopoietic cell transplant (HCT) for non-malignant disorders (NMD). Understanding the incidence and risk factors for GVHD in children with NMD is an important step in developing strategies for its prevention. Study Design: This is a retrospective, registry, study that included children with NMD receiving HCT in 5 centers in Florida between 2010 and 2019. Results: Among 183 patients evaluable for GVHD, acute GVHD (aGVHD) grades I, II, III, and IV were present in 18%, 12.6%, 3.8% and 5.5% of patients, respectively. Limited and extensive chronic GVHD (cGVHD), were observed in 8.7% and 12.6% of patients. Patients with aGVHD grade III/IV had significantly lower 3-year survival rates than those without aGVHD, or those with aGVHD grade I/II (52.9% [95% confidence interval (CI) 34-83] vs. 90.1% [95% CI 84-96], vs. 98.1% [95%CI 95-100], p<0.001). Patients without cGVHD and those with limited and extensive cGVHD had 3-year survival rates of 88.9% [95%CI 84-94], 91.7% [95%CI 77-100], and 84.8% [95%CI 70-100], respectively, log rank p=0.3. Receiving transplant from an HLA-mismatched unrelated donor (MMUD), as compared to a matched related donor (MRD), increased the risk for aGVHD grade III/IV (Odds ratio 10.4 [95% CI 2.5-47.6]). There were no cases of aGVHD grade III/IV among recipients of mismatched related/haploidentical transplants. Conclusions: Grade III/IV aGVHD, which significantly reduced overall survival, was reported in 9.3% of children with NMD receiving HCT. Risk factors included HCT from a MMUD but not mismatched related donors.

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