Critical care illness in allogeneic hematopoietic stem-cell transplantation recipients with chronic graft versus host disease

Chronic graft-versus-host disease (cGVHD) is a leading long-term complication following allogeneic hematopoietic stem-cell transplantation (Allo-HSCT). However, its impact on outcomes in critically ill Allo-HSCT recipients has little been evaluated. We conducted a post hoc analysis of a multicenter cohort study involving Allo-HSCT recipients admitted to 14 French intensive care units (ICUs) between January 1, 2015, and December 31, 2020. The primary endpoint was 90-day mortality after admission. The prevalence of cGVHD was 10% (114/1164), with a severe form of the disease in half the patients. The most common manifestation was skin involvement (94%), followed by gastrointestinal tract (56%), liver (28%), and lungs (19%). The primary reason for ICU admission was acute respiratory failure (43%), with 65% of patients presenting with multi-organ dysfunction. Overall survival was 61% at 90 days and 40% at 3 years. The Sequential Organ Failure Assessment score at ICU admission was the only independent predictor of 90-day mortality (HR/point 1.32 [95% CI 1.21–1.46]; p < 0.01). cGVHD severity did not significantly influence survival. Patients with cGVHD had comparable survival rates to those with controlled acute GVHD or without GVHD (90-day: 61% vs. 55% and 66%; 3-year: 40% vs. 32% and 47%). In critically ill Allo-HSCT recipients, the presence or severity of cGVHD is not associated with survival and should not influence the decision to admit or not the patient to the ICU. However, careful discussions about the goals of care should be undertaken in patients with severe hepatic or pulmonary involvement. Retrospectively registered.