ORIGINAL ARTICLE Outcome in critically ill patients with allogeneic BM or peripheral haematopoietic SCT: a single-centre experience P Depuydt 1,3 , T Kerre 2 , L Noens 2 , J Nollet 1 , F Offner 2 , J Decruyenaere 2 and D Benoit 1 1 Department of Intensive Care, Ghent University Hospital, Ghent, Belgium; 2 Department of Hematology, Ghent University Hospital, Ghent, Belgium and 3 Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium Outcome in haematological patients who develop critical illness has significantly improved over the last two decades, but less so in allogeneic BMT recipients. We prospectively investigated the outcome of 44 haematological patients with allogeneic BM or haematopoietic SCT (ABMT/ AHSCT) requiring admission to the intensive care unit (ICU) of Ghent University Hospital between January 2000 and December 2007. We related outcome to the cause of critical illness, which was categorized as documented or clinically suspected bacterial infection, non-bacterial infection and non-infectious disease. Mechanical ventila- tion was required in 32 patients, and 12 patients received renal replacement therapy. Overall ICU-mortality, in- hospital mortality and 6-month mortality rates were 61, 75 and 80%, respectively. Hospital mortality rates in patients with bacterial infection (n ¼ 14), non-bacterial infection (n ¼ 13) and non-infectious disease (n ¼ 17) were 43, 85 and 94% (P ¼ 0.003). After adjustment for severity of illness sequential organ failure assessment (SOFA) score, bacterial infection (odds ratio 0.06, 0.01–0.36, P ¼ 0.002) was associated with significantly lower odds for hospital mortality. On the basis of our experience, ICU referral of ABMT/AHSCT patients is justifiable, as an acceptable fraction of these patients have longer-term survival. Documented or clinically suspected bacterial infection as the cause of critical illness is associated with better prognosis in comparison with other causes. Bone Marrow Transplantation (2011) 46, 1186–1191; doi:10.1038/bmt.2010.255; published online 1 November 2010 Keywords: allogeneic BMT; allogeneic haematopoietic SCT; intensive care unit Introduction Allogeneic BM or haematopoietic SCT (ABMT/AHSCT) is a highly effective therapy in haematological malignancy, resulting in increased definitive cure rates or extended disease-free survival in various high-risk haematological diseases. 1 However, the procedure is associated with significant morbidity and mortality, which is especially high when referral to the intensive care unit (ICU) is required because of major organ dysfunction. ICU admis- sion is necessary in 24–40% of ABMT/AHSCT patients during the phase of conditioning, engraftment and recov- ery, 2,3 and in 19% of patients after the initial transplant. 4 Providing prolonged ICU treatment in these patients in case of multiple organ failure has been considered as inappropriate care, as their survival is judged to be disproportionately low with regard to the invested resources and the endured suffering of the patients and their beloved during ICU stay. 5–7 In earlier studies, investigators aimed to identify subsets of ABMT/AHSCT patients in whom ICU care is con- sidered futile, stratifying patients into categories with increasing degree of organ failure or requirement of organ support, such as acute respiratory failure necessitating mechanical ventilation (MV), shock requiring vasopressors or acute kidney injury with the need for renal replacement therapy (RRT). 8–10 However, apart from a measure of organ failure itself, its underlying cause may be an important factor predicting outcome. For instance, it has been found that acute respiratory failure in cancer patients caused by reversible and/or treatable conditions has a better prognosis than acute respiratory failure resulting from irreversible or intractable disease, or when its cause remains unclear. 11–13 In this study, we report on the short- and longer-term outcome of a cohort of ABMT/AHSCT patients admitted to our ICU between 2000 and 2007, relating prognosis to the cause of critical illness. Patients and methods This study was conducted at the medical ICU of the Ghent University Hospital, a tertiary care academic centre with 1062 beds, and included all consecutive ABMT/AHSCT patients admitted from January 2000 to December 2007. The 14-bed medical ICU is staffed by three full-time intensive care physicians working according to the closed- unit principle. A senior staff physician is present and consultants of different disciplines are available 24 h a day, Received 13 April 2010; revised 9 September 2010; accepted 11 September 2010; published online 1 November 2010 Correspondence: Dr P Depuydt, Department of Intensive Care, Ghent University Hospital, De Pintelaan 185, Ghent 9000, Belgium. E-mail: pieter.depuydt@ugent.be Bone Marrow Transplantation (2011) 46, 1186–1191 & 2011 Macmillan Publishers Limited All rights reserved 0268-3369/11 www.nature.com/bmt