Factors associated with treatment resumption and long-term outcomes after ICU discharge in patients with hematological malignancies.

PURPOSE: Post-intensive care syndrome may result in persistent functional impairments that may jeopardize the feasibility of anticancer therapy in patients with hematological malignancies (HMs), thereby adversely affecting long-term survival. Our purpose was to identify factors associated with anticancer therapy resumption after ICU discharge and to assess five-year survival. METHODS: This single-center retrospective observational study included consecutive adults with HMs admitted to intensive care unit (ICU) between 2014 and 2019. Multivariable analyses were performed to identify factors associated with anticancer treatment resumption and with survival. RESULTS: We included 252 patients. The most common malignancies were aggressive lymphoma (n = 71, 28.2%), acute leukemia (n = 47, 18.7%), and multiple myeloma (n = 42, 16.7%). Performance status worsened significantly during the ICU stay (median change, -1.0; 95%CI, -1.0 to -1.0; P < 0.001). Of the 171 patients (67.9%) discharged alive from the ICU, 119 had an indication for further anticancer therapy; among them, 106 (89.1%) resumed treatment, although modifications of the regimen were required in 20/103 (19.4%). By multivariable analysis, cardiovascular disease was independently associated with a lower likelihood of treatment resumption (hazard ratio [HR], 0.41; 95%CI, 0.20-0.84; P = 0.014) and diagnosis of the HM during the ICU stay with a higher likelihood of treatment resumption (HR, 3.03; 95%CI, 1.53-6.01; P = 0.002). Survival rates after ICU admission were 50.0% at six months, 46.0% at one year, 41.3% at two years, 38.9% at three years, and 36.1% at five years. Factors independently associated with a lower risk of five-year mortality were infection (HR, 0.54; 95%CI, 0.33-0.87; P = 0.011), HM diagnosed during the ICU stay (HR, 0.31; 95%CI, 0.12-0.81; P = 0.018), and classification as other HMs (HR, 0.40; 95%CI, 0.19-0.86; P = 0.019). CONCLUSIONS: In patients with HMs, ICU survival was substantial and most deaths occurred during the ICU stay or within the first post-ICU year. Most survivors were able to resume anticancer therapy despite exhibiting functional decline. Long-term outcomes in survivors were primarily related to the nature of the underlying disease and to cardiovascular comorbidities. Both the oncological prognosis and the cardiovascular status should be considered when making intensive-care decisions.