Acute respiratory failure and the kinetics of neutrophil recovery in pediatric hematopoietic cell transplantation: a multicenter study

Bone Marrow Transplant. 2020 Feb;55(2):341-348. doi: 10.1038/s41409-019-0649-3. Epub 2019 Sep 16.


In this multicenter study, we investigated the kinetics of neutrophil recovery in relation to acuity and survival among 125 children undergoing allogeneic hematopoietic cell transplantation (allo-HCT) who required invasive mechanical ventilation (IMV). Recovery of neutrophils, whether prior to or after initiation of IMV, was associated with a significantly decreased risk of death relative to never achieving neutrophil recovery. A transient increase in acuity (by oxygenation index and vasopressor requirements) occurred among a subset of the patients who achieved neutrophil recovery after initiation of IMV; 61.5% of these patients survived to discharge from the intensive care unit (ICU). Improved survival among patients who subsequently achieved neutrophil recovery on IMV was not limited to those with peri-engraftment respiratory distress syndrome. The presence of a respiratory pathogen did not affect the risk of death while on IMV but was associated with an increased length of IMV (p < 0.01). Among patients undergoing HCT who develop respiratory failure and require advanced therapeutic support, neutrophil recovery at time of IMV and/or presence of a respiratory pathogen should not be used as determining factors when counseling families about survival.

Publication types

  • Multicenter Study

MeSH terms

  • Child
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Humans
  • Kinetics
  • Neutrophils
  • Respiration, Artificial
  • Respiratory Distress Syndrome*
  • Respiratory Insufficiency* / etiology
  • Respiratory Insufficiency* / therapy