Gupta N, Maurya P, Maurya P, Gupta A. Critical care in hematopoietic stem cell transplantation: Common complications and management. World J Crit Care Med 2026; 15(1): 113235 [DOI: 10.5492/wjccm.v15.i1.113235]
Corresponding Author of This Article
Nishkarsh Gupta, MD, Professor, Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, Room No. 139 FF IRCH, New Delhi 110029, Delhi, India. drnishkarsh@rediffmail.com
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Critical Care Medicine
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Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Mar 9, 2026 (publication date) through Mar 6, 2026
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Publication Name
World Journal of Critical Care Medicine
ISSN
2220-3141
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Gupta N, Maurya P, Maurya P, Gupta A. Critical care in hematopoietic stem cell transplantation: Common complications and management. World J Crit Care Med 2026; 15(1): 113235 [DOI: 10.5492/wjccm.v15.i1.113235]
Nishkarsh Gupta, Prateek Maurya, Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Prakriti Maurya, Department of Anaesthesia and Critical Care, Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Tata Cancer Hospital, Varanasi 221005, Uttar Pradesh, India
Anju Gupta, Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Co-corresponding authors: Nishkarsh Gupta and Anju Gupta.
Author contributions: Gupta N conceptualized the review, performed the majority of the writing, prepared and organized figures and tables, and supervised the overall manuscript development; Maurya Prat conducted literature search, data extraction, and contributed equally to the drafting and structuring of the manuscript as co-first author; Maurya Prak critically appraised the literature, wrote selected sections, and assisted in editing and formatting; Gupta A contributed to manuscript design, provided in-depth revisions for important intellectual content, guided the clinical interpretation, and approved the final version of the manuscript for submission; Gupta N and Gupta A have played important and indispensable roles in the manuscript preparation as the co-corresponding authors.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this manuscript.
Corresponding author: Nishkarsh Gupta, MD, Professor, Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, Room No. 139 FF IRCH, New Delhi 110029, Delhi, India. drnishkarsh@rediffmail.com
Received: August 20, 2025 Revised: September 13, 2025 Accepted: December 1, 2025 Published online: March 9, 2026 Processing time: 192 Days and 21.8 Hours
Abstract
This narrative review synthesizes contemporary evidence regarding critical care complications following hematopoietic stem cell transplantation (HSCT) and evaluates management strategies for improving outcomes in this complex population. We conducted a comprehensive literature search of MEDLINE/PubMed databases from January 2014 to December 2024, focusing on critical care complications, prognostic factors, and therapeutic interventions in HSCT recipients. Intensive care unit (ICU) admission affects 8.8%-40% of HSCT recipients, with contemporary 30-day survival reaching 57.7% in specialized centers. Respiratory failure predominates as the primary indication for ICU support. The Lung Injury Prevention Score for Bone Marrow Transplant demonstrates strong predictive accuracy for acute respiratory distress syndrome development. Novel therapeutic approaches show promise, including inhaled tranexamic acid protocols for diffuse alveolar hemorrhage showing promising hemostasis rates in cohort studies, though randomized controlled trial data are lacking. JAK inhibitors achieve improved response rates compared to best available therapy for steroid-refractory graft-versus-host disease (GVHD). The Mount Sinai Acute GVHD International Consortium algorithm provides validated biomarker-based prognostication. Post-transplant cyclophosphamide reduces acute GVHD incidence, while complement inhibition improves outcomes in transplant-associated thrombotic. Early recognition using validated scoring systems and integration of standard ICU protocols with specialized HSCT expertise are essential for optimizing outcomes. Despite advances, significant knowledge gaps remain regarding optimal management strategies for many complications, with most evidence derived from retrospective cohort studies.
Core Tip: Critical care management of hematopoietic stem cell transplantation recipients has evolved from historically poor outcomes to contemporary 30-day intensive care unit (ICU) survival approaching 60% in specialized centers. Respiratory failure remains the predominant complication requiring ICU support. Integration of validated prognostic tools including the Mount Sinai Acute graft-versus-host disease International Consortium algorithm probability with targeted therapies and early intervention strategies represents the current standard of care for optimizing outcomes in this vulnerable population.
