The following is a summary of “Impact of critical illness on continuation of anticancer treatment and prognosis of patients with aggressive hematological malignancies,” published in the September 2024 issue of Critical Care by Bredin et al.
An essential predictive characteristic of aggressive hematological malignancies is maintaining the dose intensity of cancer treatment.
Researchers conducted a retrospective study to estimate the long-term outcomes of intensive care unit (ICU) survivors with acute myeloid leukemia (AML) or aggressive B-cell non-Hodgkin lymphoma (B-NHL), concentrating on the resumption of the intended optimal cancer treatment regimen.
They examined patients with AML and aggressive B-NHL who outlived an unexpected ICU admission. The preliminary endpoint was the change in the cancer treatment after ICU discharge. Secondary endpoints were 1-year progression-free survival and overall survival rates. Factors linked with changes in cancer treatment were evaluated using multivariate logistic regression to determine factors linked with changes in cancer treatment.
The results showed 366 patients with AML or aggressive B-NHL were admitted to the ICU, with 170 survivors (AML: n=92; B-NHL: n=78), of which 68% had been analyzed with hematological malignancies. The admission Sequential Organ Failure Assessment (SOFA) score was 5 (interquartile range 4–8). During their ICU stay, 30 patients (17.6%) needed invasive mechanical ventilation, 29 (17.0%) needed vasopressor support, and 16 (9.4%) experienced renal replacement therapy. The 1-year survival rate after ICU discharge was 59.5%. Treatment modifications of 72 patients were (42%). Multivariate analysis demonstrated that age >65 years (odds ratio [OR] 3.54 [95% CI 1.67–7.50], P< 0.001), ICU-discharge hyperbilirubinemia >20 µmol/L (OR 3.01 [1.10–8.15], P=0.031), and therapeutic limitations (OR 16.5 [1.83–149.7], P=0.012) was unaided related to modifications in cancer treatment. Post-ICU treatment mutations affected in-hospital, 1-year overall survival, and progression-free survival.
They concluded that 58% of survivors of ICU with aggressive hematological malignancies restarted their cancer treatment, with age, constant liver dysfunction, and findings to limit life-support therapies independently related to treatment changes merged to poorer 1-year outcomes.
Sources: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01372-5
