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Intensive care unit admission in patients with T cell lymphomas: clinical features and outcome

  • Guillaume Dumas
  • Lucie Biard
  • Claire Givel
  • Sandy Amorim
  • Lara Zafrani
  • Virginie Lemiale
  • Eric Mariotte
  • Elie Azoulay
  • Catherine Thiéblemont
  • Emmanuel Canet
Original Article

Abstract

T cell non-Hodgkin lymphomas (T-NHLs) are aggressive malignancies which have a high risk of life-threatening complications. However, their prognosis in the intensive care unit (ICU) setting has not yet been assessed. We conducted a study including 87 ICU patients either with newly diagnosed T-NHLs or those undergoing first-line therapy admitted between January 1, 2000, and December 31, 2014. The primary subtypes were peripheral T cell lymphoma (PTCL) (n = 41, 47%), anaplastic large-cell lymphoma (ALCL) (n = 13, 15%), and adult T-leukaemia/lymphoma (ATLL) (n = 11, 13%). Six in every ten patients had malignancy-related complications (haemophagocytic syndrome 37%, tumour lysis syndrome 18% and hypercalcaemia 9%), while infections accounted for one quarter of ICU admissions. Nine fungal infections were documented, including six invasive aspergillosis. Urgent chemotherapy was started in the ICU in 59% of the patients, and urgent surgery was required in 13%. ICU and day-90 mortality were 22% and 41%, respectively. Multivariate analysis showed that SOFA score at day 1, age, sepsis and haemophagocytic syndrome were independent predictors of day-90 mortality. Compared to 66 ICU-matched controls with non-Hodgkin B cell lymphomas, patients with T-NHLs had a similar ICU survival. Overall survival rates of patients with T cell NHLs and B cell NHLs were 20% and 46%, respectively (hazard ratio for death associated with T cell NHLs 2.00 [1.12–3.58]). Patients with T cell NHLs had a very poor long-term outcome. Although the high rate of short-term survival suggests that an ICU trial is a reasonable option for patients newly diagnosed for the malignancy, extended stay in the ICU or further readmission should be considered only for highly selected patients who respond to the haematological treatment.

Keywords

Fungal infection Haemophagocytic syndrome Intensive care unit T cell lymphoma Tumour lysis syndrome 

Abbreviations

AITL

angioimmunoblastic T cell lymphoma

ALCL

anaplastic large-cell lymphoma ALK+

ATLL

adult T cell leukaemia/lymphoma

AUC

area under the curve

COPD

chronic obstructive pulmonary disease

HIV

human immunodeficiency virus

HM

haematological malignancies

HSTCL

hepatosplenic T cell lymphoma

ICU

intensive care Unit

IFI

invasive fungal infection

IPI

international pronostic index

IQR

interquartile range

LDH

lactate dehydrogenase

NHL

non-Hodgkin’s lymphoma

NK/TCL

NK/T cell lymphoma

PS

performance status

PTCL-NOS

peripheral T cell Lymphoma-Not otherwise specified

PTCL

peripheral T cell lymphomas

SOFA

sequential organ failure assessment

Notes

Acknowledgments

We thank Victoria Mears for helping with English editing.

Compliance with ethical standards

This study was approved by our institutional review board (CECIC Clermont Ferrand – IRB no.5891; Ref. 2007-16). According to French law, informed consent was not required in this retrospective observational study in which the collected data were anonymised.

Conflict of interest

GD, LB, CG, SA, LZ, VL, EM, CT and EC declare that they have no competing interests. EA declares the following statements: board member for Gilead, lectures for Alexion, MSD, Astellas, and research grants from MSD, Fisher & Payckle, Pfizer (2012).

Supplementary material

277_2018_3496_MOESM1_ESM.docx (17 kb)
Supplementary Table 1 (DOCX 81 kb)
277_2018_3496_MOESM2_ESM.docx (69 kb)
Supplementary Table 2 (DOCX 68 kb)

References

  1. 1.
    Perry AM, Jacques D, Nathwani BN et al (2015) Classification of non-Hodgkin lymphoma in seven geographic regions around the world: review of 4539 cases from the international non-Hodgkin lymphoma classification project. Blood 126:1484–1484Google Scholar
  2. 2.
    Armitage JO, Gascoyne RD, Lunning MA, Cavalli F (2017) Non-Hodgkin lymphoma. Lancet Lond Engl 390:298–310.  https://doi.org/10.1016/S0140-6736(16)32407-2 CrossRefGoogle Scholar
  3. 3.
    Zafrani L, Azoulay E (2014) How to treat severe infections in critically ill neutropenic patients? BMC Infect Dis 14:512.  https://doi.org/10.1186/1471-2334-14-512 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Azoulay E, Pène F, Darmon M, Lengliné E, Benoit D, Soares M, Vincent F, Bruneel F, Perez P, Lemiale V, Mokart D, Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique (Grrr-OH) (2015) Managing critically ill hematology patients: time to think differently. Blood Rev 29:359–367.  https://doi.org/10.1016/j.blre.2015.04.002 CrossRefPubMedGoogle Scholar
  5. 5.
    Azoulay E, Mokart D, Pène F, Lambert J, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Laisne LM, Rabbat A, Lebert C, Perez P, Chaize M, Renault A, Meert AP, Benoit D, Hamidfar R, Jourdain M, Darmon M, Schlemmer B, Chevret S, Lemiale V (2013) Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium—a groupe de recherche respiratoire en réanimation onco-hématologique study. J Clin Oncol Off J Am Soc Clin Oncol 31:2810–2818.  https://doi.org/10.1200/JCO.2012.47.2365 CrossRefGoogle Scholar
  6. 6.
    Benoit DD, Soares M, Azoulay E (2014) Has survival increased in cancer patients admitted to the ICU? We are not sure. Intensive Care Med 40:1576–1579.  https://doi.org/10.1007/s00134-014-3480-8 CrossRefPubMedGoogle Scholar
  7. 7.
    Vose J, Armitage J, Weisenburger D, International T-Cell Lymphoma Project (2008) International peripheral T-cell and natural killer/T-cell lymphoma study: pathology findings and clinical outcomes. J Clin Oncol Off J Am Soc Clin Oncol 26:4124–4130.  https://doi.org/10.1200/JCO.2008.16.4558 CrossRefGoogle Scholar
  8. 8.
    Abramson JS, Feldman T, Kroll-Desrosiers AR, Muffly LS, Winer E, Flowers CR, Lansigan F, Nabhan C, Nastoupil LJ, Nath R, Goy A, Castillo JJ, Jagadeesh D, Woda B, Rosen ST, Smith SM, Evens AM (2014) Peripheral T-cell lymphomas in a large US multicenter cohort: prognostication in the modern era including impact of frontline therapy. Ann Oncol Off J Eur Soc Med Oncol 25:2211–2217.  https://doi.org/10.1093/annonc/mdu443 CrossRefGoogle Scholar
  9. 9.
    Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, Advani R, Ghielmini M, Salles GA, Zelenetz AD, Jaffe ES (2016) The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 127:2375–2390.  https://doi.org/10.1182/blood-2016-01-643569 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Thiéry G, Azoulay E, Darmon M, Ciroldi M, de Miranda S, Lévy 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 Off J Am Soc Clin Oncol 23:4406–4413.  https://doi.org/10.1200/JCO.2005.01.487 CrossRefGoogle Scholar
  11. 11.
    Vincent JL, de Mendonça A, Cantraine F et al (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med 26:1793–1800CrossRefPubMedGoogle Scholar
  12. 12.
    Henter J-I, Horne A, Aricó M, Egeler RM, Filipovich AH, Imashuku S, Ladisch S, McClain K, Webb D, Winiarski J, Janka G, for the Histiocyte Society (2007) HLH-2004: diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 48:124–131.  https://doi.org/10.1002/pbc.21039 CrossRefGoogle Scholar
  13. 13.
    Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC (2016) The third international consensus definitions for Sepsis and septic shock (Sepsis-3). JAMA 315:801–810.  https://doi.org/10.1001/jama.2016.0287 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Algrin C, Faguer S, Lemiale V, Lengliné E, Boutboul D, Amorim S, Galicier L, Canet E, Thieblemont C, Azoulay E (2015) Outcomes after intensive care unit admission of patients with newly diagnosed lymphoma. Leuk Lymphoma 56:1240–1245.  https://doi.org/10.3109/10428194.2014.922181 CrossRefPubMedGoogle Scholar
  15. 15.
    Normilio-Silva K, de Figueiredo AC, Pedroso-de-Lima AC, Tunes-da-Silva G, Nunes da Silva A, Delgado Dias Levites A, de-Simone AT, Lopes Safra P, Zancani R, Tonini PC, Vasconcelos de Andrade e Silva U, Buosi Silva T, Martins Giorgi J, Eluf-Neto J, Costa A, Abrahão Hajjar L, Biasi Cavalcanti A (2016) Long-term survival, quality of life, and quality-adjusted survival in critically ill patients with Cancer. Crit Care Med 44:1327–1337.  https://doi.org/10.1097/CCM.0000000000001648 CrossRefPubMedGoogle Scholar
  16. 16.
    Zampieri FG, Bozza FA, Moralez GM, Mazza DDS, Scotti AV, Santino MS, Ribeiro RAB, Rodrigues Filho EM, Cabral MM, Maia MO, D’Alessandro PS, Oliveira SV, Menezes MAM, Caser EB, Lannes RS, Alencar Neto MS, Machado MM, Sousa MF, Salluh JIF, Soares M (2017) The effects of performance status one week before hospital admission on the outcomes of critically ill patients. Intensive Care Med 43:39–47.  https://doi.org/10.1007/s00134-016-4563-5 CrossRefPubMedGoogle Scholar
  17. 17.
    Soares M, Salluh JIF, Carvalho MS, Darmon M, Rocco JR, Spector N (2006) Prognosis of critically ill patients with cancer and acute renal dysfunction. J Clin Oncol Off J Am Soc Clin Oncol 24:4003–4010.  https://doi.org/10.1200/JCO.2006.05.7869 CrossRefGoogle Scholar
  18. 18.
    Park C-M, Koh Y, Jeon K, Na S, Lim CM, Choi WI, Lee YJ, Kim SC, Chon GR, Kim JH, Kim JY, Lim J, Rhee CK, Park S, Kim HC, Lee JH, Lee JH, Park J, Cho J, Koh SO, Suh GY, Validation of Simplified acute physiology score 3 in Korean Intensive care unit (VSKI) study group, Korean Study Group on Respiratory Failure (KOSREF) (2014) Impact of eastern cooperative oncology group performance status on hospital mortality in critically ill patients. J Crit Care 29:409–413.  https://doi.org/10.1016/j.jcrc.2014.01.016 CrossRefPubMedGoogle Scholar
  19. 19.
    Taccone FS, Van den Abeele A-M, Bulpa P et al (2015) Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes. Crit Care Lond Engl 19:7.  https://doi.org/10.1186/s13054-014-0722-7 CrossRefGoogle Scholar
  20. 20.
    Bassetti M, Garnacho-Montero J, Calandra T, Kullberg B, Dimopoulos G, Azoulay E, Chakrabarti A, Kett D, Leon C, Ostrosky-Zeichner L, Sanguinetti M, Timsit JF, Richardson MD, Shorr A, Cornely OA (2017) Intensive care medicine research agenda on invasive fungal infection in critically ill patients. Intensive Care Med 43:1225–1238.  https://doi.org/10.1007/s00134-017-4731-2 CrossRefPubMedGoogle Scholar
  21. 21.
    Lortholary O, Gangneux J-P, Sitbon K, Lebeau B, de Monbrison F, le Strat Y, Coignard B, Dromer F, Bretagne S, French Mycosis Study Group (2011) Epidemiological trends in invasive aspergillosis in France: the SAIF network (2005-2007). Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis 17:1882–1889.  https://doi.org/10.1111/j.1469-0691.2011.03548.x CrossRefGoogle Scholar
  22. 22.
    Romani L (2011) Immunity to fungal infections. Nat Rev Immunol 11:275–288.  https://doi.org/10.1038/nri2939 CrossRefGoogle Scholar
  23. 23.
    Wohlfarth P, Carlström A, Staudinger T, Clauss S, Hermann A, Rabitsch W, Bojic A, Skrabs C, Porpaczy E, Schiefer AI, Valent P, Knöbl P, Agis H, Hauswirth A, Jäger U, Kundi M, Sperr WR, Schellongowski P, Arbeitsgruppe für hämato-onkologische Intensivmedizin der Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin (ÖGIAIN) (2016) Incidence of intensive care unit admission, outcome and post intensive care survival in patients with diffuse large B-cell lymphoma. Leuk Lymphoma 57:1831–1838.  https://doi.org/10.3109/10428194.2015.1106537 CrossRefPubMedGoogle Scholar
  24. 24.
    Foss FM, Zinzani PL, Vose JM, Gascoyne RD, Rosen ST, Tobinai K (2011) Peripheral T-cell lymphoma. Blood 117:6756–6767.  https://doi.org/10.1182/blood-2010-05-231548 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Guillaume Dumas
    • 1
  • Lucie Biard
    • 2
  • Claire Givel
    • 1
  • Sandy Amorim
    • 3
  • Lara Zafrani
    • 1
    • 4
  • Virginie Lemiale
    • 1
  • Eric Mariotte
    • 1
  • Elie Azoulay
    • 1
    • 4
  • Catherine Thiéblemont
    • 3
    • 4
  • Emmanuel Canet
    • 1
  1. 1.Medical Intensive Care Unit, AP-HPSaint-Louis University HospitalParisFrance
  2. 2.Biostatistics Department, AP-HPSaint-Louis University HospitalParisFrance
  3. 3.Hemato-Oncology DepartmentSaint-Louis University HospitalParisFrance
  4. 4.Paris Diderot University, Sorbonne Paris CitéParisFrance

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