Continued survival gains in recent years among critically ill myeloma patients

Byline: Vincent Peigne (1), KateAina Rusinova (1), Lionel Karlin (2), Michael Darmon (1), Jean-Paul Fermand (2), Benoit Schlemmer (1), Elie Azoulay (1,3) Keywords: Bone marrow transplantation; Acute respiratory failure; Noninvasive mechanical ventilation; Sepsis; Early admission 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 (P = 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. Author Affiliation: (1) Medical ICU, AP-HP, Hopital Saint-Louis, 75010, Paris, France (2) Department of Immunology, AP-HP, Hopital Saint-Louis, 75010, Paris, France (3) Service de Reanimation Medicale, Hopital Saint-Louis et Universite Paris 7, 1 rue Claude Vellefaux, 75010, Paris, France Article History: Registration Date: 02/10/2008 Received Date: 01/05/2008 Accepted Date: 08/09/2008 Online Date: 14/10/2008