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Updated: May 20, 2026
Intrafemoral Injection of Human Hematopoietic Stem and Progenitor Cells into Immunocompromised Mice
Published on: December 8, 2023
Improved outcomes for stem cell transplant recipients requiring pediatric intensive care
Ranjit S Chima1, Rodney C Daniels, Mi-Ok Kim
1Divisions of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA. ranjit.chima@cchmc.org
Insights
Survival rates for pediatric hematopoietic stem cell transplant patients admitted to the pediatric intensive care unit are improving, with 63% surviving discharge and 45% alive long-term. Prior ICU admissions decreased survival odds.
Area of Science:
- Hematology
- Pediatric Critical Care
- Transplant Medicine
Background:
- Hematopoietic stem cell transplantation (HSCT) is a life-saving procedure for pediatric patients with various hematologic and oncologic conditions.
- Admission to the pediatric intensive care unit (PICU) for HSCT recipients indicates a high-risk clinical course.
- Previous studies suggest variability in outcomes for HSCT patients requiring intensive care.
Purpose of the Study:
- To review the outcomes of HSCT patients admitted to the PICU.
- To identify factors influencing survival in this high-risk population.
Main Methods:
- Retrospective database review of HSCT patients admitted to the PICU.
- Data collected from July 2004 to June 2010 at a children's hospital.
Main Results:
- Out of 448 HSCT patients, 155 (35%) required 319 PICU admissions.
- Sixty-three percent (97/155) of patients survived to PICU discharge, with 45% alive at long-term follow-up (median >2 years).
- Factors associated with survival included lower Pediatric Risk of Mortality II scores, shorter PICU stay, and less need for mechanical ventilation and renal support. Each prior PICU admission reduced survival odds.
Conclusions:
- A 63% survival rate to PICU discharge and 45% long-term survival were observed in HSCT patients admitted to the PICU over a 6-year period.
- These findings suggest an improvement in survival outcomes for this vulnerable patient group.
- Minimizing prior PICU admissions may be crucial for enhancing overall survival in HSCT recipients requiring intensive care.
Objectives:
Survival for hematopoietic stem cell transplant patients requiring pediatric intensive care unit admission may be improving. This study was conducted to review outcomes for patients undergoing hematopoietic stem cell transplantation requiring admission to our pediatric intensive care unit and to identify variables impacting survival.
Design:
Retrospective database review.
Setting:
Pediatric intensive care unit and bone marrow transplant service of a children's hospital.
Patients:
Patients undergoing hematopoietic stem cell transplantation at our center from July 2004 through June 2010 requiring pediatric intensive care unit admission during the same period.
Measurements And Main Results:
Thirty-five percent of patients (155 of 448) undergoing hematopoietic stem cell transplantation required 319 admissions over this period. Of these 155 patients, 63% (97 of 155) were discharged alive following their most recent admission with a 100-day survival of 51% (79 of 155). Forty-five percent (69 of 155) of patients were still alive on long-term follow-up. Intubation and mechanical ventilation were required for 57% (88 of 155) of patients, with 39% (34 of 88) of patients surviving their last pediatric intensive care unit admission. Renal support was utilized for 25% (38 of 155) of patients with 34% (13 of 38) survival to pediatric intensive care unit discharge. Admissions surviving to pediatric intensive care unit discharge had significantly lower Pediatric Risk of Mortality II scores, shorter pediatric intensive care unit length of stay, lower utilization of intubation and mechanical ventilation with fewer ventilator days, and lower use of renal support when compared to nonsurvivors. Of note, each prior pediatric intensive care unit admission significantly reduced the odds of pediatric intensive care unit survival.
Conclusions:
We report a 63% survival to pediatric intensive care unit discharge, with 45% surviving at a median follow-up of over 2 yrs for all hematopoietic stem cell transplantation patients admitted to our pediatric intensive care unit over a 6-yr period. Our data suggest improved survival outcomes for this high risk patient population.
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