Background: Hyperbaric oxygen therapy (HBO) has been used for various type of refractory infections in patients with hematologic malignancies. Despite of its prevalent use, efficacy of HBO in such population has been poorly studied.
Aims: Here, we reviewed our clinical experience with HBO use for patients with hematologic malignancies including patients that had undergone a stem-cell transplant.
Methods: The study patients were identified by insurance authorization data related to HBO treatment between December 2012 and October 2019 at a single tertiary cancer center. Patients with the underlying diagnosis of hematologic malignancies were included. Demographic and clinical data were collected retrospectively.
Results: 49 patients were included. Median age at HBO therapy was 51 years (range 22-86). Most common underlying disease was acute myeloid leukemia (53%), followed by acute lymphoblastic leukemia (18%), myelodysplastic syndrome (10%) and non-Hodgkin’s lymphoma (8%). 34 (68%) patients had active disease including 28 (57%) patients with relapsed/refractory disease. Thirty (61%) patients were stem-cell transplant (SCT) recipients. Median time from SCT to HBO was 102 days. Majority of patients (88%) were SCT recipients within 6 month or having active malignancies at time of HBO therapy.
Twenty-five (51%) patients had neutropenia at HBO initiation, only 5 patients recovered counts at the end of HBO. Treatment indications included: BK cystitis (37%), fungal sinusitis (33%), cellulitis (20%), non-BK cystitis (8%) and other fungal infection (2%). Median number of HBO sessions was 5 (range 1–60), and median HBO duration was 17 days (range 1–109 days).
Forty-four patients were evaluable for response of their infection to HBO treatment: 52% had improvement, 6% had stable infection, and 41% failed to respond. Twenty-four (49%) patients had uncontrolled infection at the last follow-up, including 8 out of 25 patients who achieved some improvement from HBO.
Median survival from HBO was 3.0 months (range 0.2-81.1). Sixty-day and 6-month mortality were 33% and 65%, respectively. Mortality from indicated infection with or without underlying disease was 37%, death was attributed to underlying disease progression in 66% of the patients and to infections in 34% of the patients. Twenty-seven (55%) patients were discharged from the hospital to outpatient care after HBO, 15 (31%) patients were discharged to hospice, and 7 (14%) patients died in the hospital.
Fourteen (32%) patients had recovery that we defined as being discharged from hospital with improved or stable infections after HBO responses. Patients with non-BK cystitis (OR 7.01, p=.087) or patients in remission of underlying hematologic malignancies without recent (within 6 months) SCT (OR 5.6, p=.049) were more likely to be recovered. Patients with recovery had superior survival than rest of patients (median 14.0 months, HR 0.28, p=.001)
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Summary/Conclusion: Majority of patients who received HBO therapy were severely immunocompromised with active hematological disease, receiving chemotherapy or recent SCT receipt. Overall these patients had a dismal outcome with short median survival at 3.0 months, death was not only from infection but also from underlying disease. A subset (32%) of patients achieved control of the infection and a longer survival after HBO therapy; these patients were more likely to have achieved a remission of their hematological malignancy without recent SCT history. Additional studies are needed to identify the right population who would benefit from HBO treatment.