Among the most challenging patients cared for in critical care medicine are the recipients of hematopoietic stem cell transplantation (HSCT). HSCT is now widely used as a definitive therapy for the treatment of pediatric malignancies and inborn errors of metabolism. Critical care services are required for treatment of complications of HSCT. Formerly thought to have an essentially futile prognosis, outcomes from critical care of HSCT patients have demonstrated steady improvement in many areas during the past two decades. Improvements in the management of respiratory failure, sepsis, and multiple organ system failure have resulted from improvement in oncology and critical care practices. Herein, we review the methods available for outcomes prediction, recent advances in critical care of HSCT patients, and possible directions for future investigation.