Log in | Register

Continued survival gains in recent years among critically ill myeloma patients

Vincent Peigne| Kateřina Rusinová| Lionel Karlin| Michael Darmon| Jean-Paul Fermand| Benoît Schlemmer| Élie Azoulay
Original
Volume 35, Issue 3 / March , 2009

Pages 512 - 518

Abstract

Objective

Therapeutic advances have improved survival in patients with myeloma (MM) over the past decade. We investigated whether survival has also improved in critically ill myeloma patients.

Design

Retrospective study.

Setting

Intensive care unit.

Patient

Consecutive myeloma patients admitted to a teaching hospital ICU between 1990 and 2006. We compared three year-of-admission groups (1990–1995, 1996–2001, and 2002–2006) that matched changes in myeloma treatment (chemotherapy only, stem cell transplantation, and new molecules, respectively).

Intervention

None.

Measurements and main results

We included 196 patients. Reasons for ICU admission and patient characteristics were similar across groups; however, less use of conventional chemotherapy and radiotherapy and greater use of steroids were noted in the more recent periods. Over time, vasopressors and invasive mechanical ventilation were used decreasingly, and noninvasive ventilation increasingly, to treat acute respiratory failure. Hospital mortality decreased from 75% in 1990–1995 to 49% in 1996–2001 and 40% in 2002–2006 (= 0.0007). Mortality was associated with poor performance status [OR 2.27, 95% CI (1.04–4.99)], need for mechanical ventilation [OR 4.33, 95% CI (1.86–10.10)], need for vasopressors [OR 2.57, 95% CI (1.12–5.86)], and admission for an event related to myeloma progression [OR 2.77, 95% CI (1.13–6.79)]. ICU admission within 48 h after hospital admission was associated with lower mortality [OR 0.28, 95% CI (0.19–0.89)].

Conclusion

Hospital mortality decreased significantly over the last 15 years in myeloma patients admitted to the ICU. Risk factors for death were organ failure and poor chronic health status. Early ICU admission was associated with lower mortality, suggesting opportunities for further improving survival.

Keywords

References

  1. Brenner H, Gondos A, Pulte D (2008) Recent major improvement in long-term survival of younger patients with multiple myeloma. Blood 111:2521–2526
    • View reference on PubMed
    • View reference on publisher's website
  2. Kumar SK, Rajkumar SV, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK, Zeldenrust SR, Dingli D, Russell SJ, Lust JA, Greipp PR, Kyle RA, Gertz MA (2008) Improved survival in multiple myeloma and the impact of novel therapies. Blood 111:2516–2520
    • View reference on PubMed
    • View reference on publisher's website
  3. Barlogie B, Tricot G, Anaissie E, Shaughnessy J, Rasmussen E, van Rhee F, Fassas A, Zangari M, Hollmig K, Pineda-Roman M, Lee C, Talamo G, Thertulien R, Kiwan E, Krishna S, Fox M, Crowley J (2006) Thalidomide and hematopoietic-cell transplantation for multiple myeloma. N Engl J Med 354:1021–1030
    • View reference on PubMed
    • View reference on publisher's website
  4. Kyle RA, Rajkumar SV (2004) Multiple myeloma. N Engl J Med 351:1860–1873
    • View reference on PubMed
    • View reference on publisher's website
  5. Richardson PG, Sonneveld P, Schuster MW, Irwin D, Stadtmauer EA, Facon T, Harousseau JL, Ben-Yehuda D, Lonial S, Goldschmidt H, Reece D, San-Miguel JF, Blade J, Boccadoro M, Cavenagh J, Dalton WS, Boral AL, Esseltine DL, Porter JB, Schenkein D, Anderson KC (2005) Bortezomib or high-dose dexamethasone for relapsed multiple myeloma. N Engl J Med 352:2487–2498
    • View reference on PubMed
    • View reference on publisher's website
  6. Singhal S, Mehta J, Desikan R, Ayers D, Roberson P, Eddlemon P, Munshi N, Anaissie E, Wilson C, Dhodapkar M, Zeddis J, Barlogie B (1999) Antitumor activity of thalidomide in refractory multiple myeloma. N Engl J Med 341:1565–1571
    • View reference on PubMed
    • View reference on publisher's website
  7. Porcher R, Levy V, Fermand JP, Katsahian S, Chevret S, Ravaud P (2002) Evaluating high dose therapy in multiple myeloma: use of quality-adjusted survival analysis. Qual Life Res 11:91–99
    • View reference on PubMed
    • View reference on publisher's website
  8. Azoulay E, Recher C, Alberti C, Soufir L, Leleu G, Le Gall JR, Fermand JP, Schlemmer B (1999) Changing use of intensive care for hematological patients: the example of multiple myeloma. Intensive Care Med 25:1395–1401
  9. Dimopoulos M, Spencer A, Attal M, Prince HM, Harousseau JL, Dmoszynska A, San Miguel J, Hellmann A, Facon T, Foa R, Corso A, Masliak Z, Olesnyckyj M, Yu Z, Patin J, Zeldis JB, Knight RD (2007) Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. N Engl J Med 357:2123–2132
    • View reference on PubMed
    • View reference on publisher's website
  10. Weber DM, Chen C, Niesvizky R, Wang M, Belch A, Stadtmauer EA, Siegel D, Borrello I, Rajkumar SV, Chanan-Khan AA, Lonial S, Yu Z, Patin J, Olesnyckyj M, Zeldis JB, Knight RD (2007) Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America. N Engl J Med 357:2133–2142
    • View reference on PubMed
    • View reference on publisher's website
  11. Azoulay E, Alberti C, Bornstain C, Leleu G, Moreau D, Recher C, Chevret S, Le Gall JR, Brochard L, Schlemmer B (2001) Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 29:519–525
    • View reference on PubMed
    • View reference on publisher's website
  12. Larche J, Azoulay E, Fieux F, Mesnard L, Moreau D, Thiery G, Darmon M, Le Gall JR, Schlemmer B (2003) Improved survival of critically ill cancer patients with septic shock. Intensive Care Med 29:1688–1695
  13. Soares M, Salluh JI, Carvalho MS, Darmon M, Rocco JR, Spector N (2006) Prognosis of critically ill patients with cancer and acute renal dysfunction. J Clin Oncol 24:4003–4010
    • View reference on PubMed
    • View reference on publisher's website
  14. Darmon M, Ciroldi M, Thiery G, Schlemmer B, Azoulay E (2006) Clinical review: specific aspects of acute renal failure in cancer patients. Crit Care 10:211
    • View reference on PubMed
    • View reference on publisher's website
  15. Khassawneh BY, White P Jr, Anaissie EJ, Barlogie B, Hiller FC (2002) Outcome from mechanical ventilation after autologous peripheral blood stem cell transplantation. Chest 121:185–188
    • View reference on PubMed
    • View reference on publisher's website
  16. Lecuyer L, Chevret S, Thiery G, Darmon M, Schlemmer B, Azoulay E (2007) The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med 35:808–814
    • View reference on PubMed
    • View reference on publisher's website
  17. Benoit DD, Depuydt PO, Vandewoude KH, Offner FC, Boterberg T, De Cock CA, Noens LA, Janssens AM, Decruyenaere JM (2006) Outcome in severely ill patients with hematological malignancies who received intravenous chemotherapy in the intensive care unit. Intensive Care Med 32:93–99
  18. Darmon M, Thiery G, Ciroldi M, de Miranda S, Galicier L, Raffoux E, Le Gall JR, Schlemmer B, Azoulay E (2005) Intensive care in patients with newly diagnosed malignancies and a need for cancer chemotherapy. Crit Care Med 33:2488–2493
    • View reference on PubMed
    • View reference on publisher's website
  19. Azoulay E, Afessa B (2006) The intensive care support of patients with malignancy: do everything that can be done. Intensive Care Med 32:3–5
  20. Thiery G, Azoulay E, Darmon M, Ciroldi M, De Miranda S, Levy V, Fieux F, Moreau D, Le Gall JR, Schlemmer B (2005) Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol 23:4406–4413
    • View reference on PubMed
    • View reference on publisher's website
  21. Lefebvre A, Kural-Menasche S, Darmon M, Thiery G, Feugeas JP, Schlemmer B, Azoulay E (2008) Use of N-terminal pro-brain natriuretic peptide to detect cardiac origin in critically ill cancer patients with acute respiratory failure. Intensive Care Med 34:833–839
  22. Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
    • View reference on PubMed
    • View reference on publisher's website
  23. Azoulay E, Thiery G, Chevret S, Moreau D, Darmon M, Bergeron A, Yang K, Meignin V, Ciroldi M, Le Gall JR, Tazi A, Schlemmer B (2004) The prognosis of acute respiratory failure in critically ill cancer patients. Medicine (Baltimore) 83:360–370
    • View reference on publisher's website
  24. Soares M, Darmon M, Salluh JI, Ferreira CG, Thiery G, Schlemmer B, Spector N, Azoulay E (2007) Prognosis of lung cancer patients with life-threatening complications. Chest 131:840–846
    • View reference on PubMed
    • View reference on publisher's website
  25. Pene F, Aubron C, Azoulay E, Blot F, Thiery G, Raynard B, Schlemmer B, Nitenberg G, Buzyn A, Arnaud P, Socie G, Mira JP (2006) Outcome of critically ill allogeneic hematopoietic stem-cell transplantation recipients: a reappraisal of indications for organ failure supports. J Clin Oncol 24:643–649
    • View reference on PubMed
    • View reference on publisher's website
  26. Azoulay E, Mokart D, Rabbat A, Pene F, Kouatchet A, Bruneel F, Vincent F, Hamidfar R, Moreau D, Mohammedi I, Epinette G, Beduneau G, Castelain V, de Lassence A, Gruson D, Lemiale V, Renard B, Chevret S, Schlemmer B (2008) Diagnostic bronchoscopy in hematology and oncology patients with acute respiratory failure: prospective multicenter data. Crit Care Med 36:100–107
    • View reference on PubMed
  27. Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487
    • View reference on PubMed
    • View reference on publisher's website
  28. Levy V, Katsahian S, Fermand JP, Mary JY, Chevret S (2005) A meta-analysis on data from 575 patients with multiple myeloma randomly assigned to either high-dose therapy or conventional therapy. Medicine (Baltimore) 84:250–260
    • View reference on publisher's website
  29. Azoulay E, Schlemmer B (2006) Diagnostic strategy in cancer patients with acute respiratory failure. Intensive Care Med 32:808–822

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement