Outcomes of critically ill pediatric patients after haploidentical stem cell transplantation

Haploidentical peripheral blood hematopoietic stem cell transplantation (haploPBSCT) is increasingly performed for both malignant and nonmalignant diseases. This study evaluated the outcomes of critically ill patients after haploPBSCT who were admitted to the pediatric intensive care unit (PICU).

This single-center, retrospective study included pediatric patients who underwent haploPBSCT (ex vivo αβ+ T-cell and CD19+ B-cell depleted after 2012) and were admitted to the PICU between 2010 and 2023. Data were collected from electronic medical records. The primary outcomes were 30-day mortality from the time of PICU admission and in-hospital mortality. Secondary analyses examined risk factors associated with these outcomes.

A total of 63 patients met the inclusion criteria. The 30-day and in-hospital mortality rates were 33.3% and 50.8%, respectively. The most common reason for PICU admission was respiratory complications. In multivariate logistic regression analysis, chronic graft-vs.-host-disease was independently associated with 30-day mortality [p = 0.043, odds ratio (OR) 4.515; 95% confidence interval (CI): 1.050-19.414], while ventilator use was an independent predictor of in-hospital mortality [p = 0.046, OR 5.15 (95% CI: 1.029-25.724)]. Among patients who survived beyond 30 days in the PICU, 11 subsequently died, 10 of whom had received ventilator support for respiratory failure; pneumonia was the most common cause of death.

Thirty-day and in-hospital mortality rates after haploPBSCT were comparable to those reported for allogenic PBSCT. Most critically ill pediatric patients required PICU admission for respiratory complications. Ventilator use independently predicted in-hospital mortality, underscoring the importance of early detection and prevention of respiratory failure following haploPBSCT.