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Perek S, Khatib A, Izhaki N, Khalaila AS, Brenner B, Horowitz NA. A prediction model for central venous catheter-related thrombosis in patients with newly-diagnosed acute myeloid leukemia: A derivation cohort analysis. Eur J Intern Med 2022; 101:68-75. [PMID: 35527180 DOI: 10.1016/j.ejim.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Catheter-related thrombosis (CRT) is a common complication in cancer patients, that may lead to chemotherapy deferral, elevated risk for systemic infections and pulmonary embolism. This study aimed to assess CRT incidence and risk factors in newly-diagnosed acute myeloid leukemia (AML) patients and create predictive models potentially allowing to decrease CRT occurrence in this population. METHODS This retrospective single-center analysis included all AML patients treated at the Rambam Health Care Campus between 2006 and 2019. Patient clinical and laboratory data were collected to evaluate thrombosis occurrence and time from AML diagnosis to CRT development. Multivariate classification models were created using logistic regression (LR) and competing risk analyzes. RESULTS The final analysis included 632 newly-diagnosed AML patients (mean age 54 ± 15 years). CRT incidence was 10.1% [confidence interval (CI) 7.7-12.9%], median time from AML diagnosis to CRT was 12.5 days [interquartile range 6-30]. In an LR multivariate model, prior history of venous thromboembolism [adjusted odds ratio (AOR) 12.046, p < 0.0001], acute promyelocytic leukemia (APL) (AOR 2.824, p = 0.015), a high body mass index and initial platelet counts <100 × 10E9/L (AOR 1.059 and 0.546; p = 0.011 and 0.040, respectively) were significantly associated with high CRT risk. Analysis of 587 non-APL patients demonstrated comparable results, with CRT incidence of 9.3% (CI 7.0%-12.1%) and emergence of chronic obstructive pulmonary disease (COPD) as a novel significant co-factor (AOR 34.491, p = 0.004). In both models, the area under curve (AUC) was ≥70%. CONCLUSIONS Significant CRT risk factors defined using the created model could be used for identification of high-risk newly-diagnosed AML patients requiring CRT prophylaxis.
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Affiliation(s)
- Shay Perek
- Department of Internal Medicine A, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel; Department of Emergency Medicine, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 1, Efron St, Haifa 3109601, Israel
| | - Alaa Khatib
- Department of Emergency Medicine, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel
| | - Niv Izhaki
- Department of Internal Medicine A, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel
| | - Ali Sleman Khalaila
- Department of Internal Medicine, Nazareth Hospital EMMS, 1611, Al Wadi Al Jawani, Nazareth 16100, Israel
| | - Benjamin Brenner
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 1, Efron St, Haifa 3109601, Israel; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel
| | - Netanel A Horowitz
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 1, Efron St, Haifa 3109601, Israel; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel.
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McKeown C, Ricciuti A, Agha M, Raptis A, Hou JZ, Farah R, Redner RL, Im A, Dorritie KA, Sehgal A, Rossetti J, Lontos K, Bovbjerg DH, Normolle D, Boyiadzis M. A prospective study of the use of central venous catheters in patients newly diagnosed with acute myeloid leukemia treated with induction chemotherapy. Support Care Cancer 2021; 30:1673-1679. [PMID: 34562168 DOI: 10.1007/s00520-021-06339-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Central venous catheters (CVCs) are widely used in acute myeloid leukemia (AML) patients. Complications associated with CVCs are frequently encountered and contribute to morbidity and mortality. Prospective studies investigating and comparing complications of different types of CVCs in AML patients and their effects on the quality of life are limited. METHODS We conducted a prospective observational study and evaluated the complications associated with the use of CVCs in adult AML patients during induction chemotherapy and evaluated quality of life outcomes as reported by the patients during and after their hospitalization. RESULTS Fifty newly diagnosed patients with AML (median age, 59 years) who received intensive induction chemotherapy were enrolled in the study. Twenty-nine patients (58%) had a peripherally inserted central catheters (PICCs) placed and 21 (42%) patients received a Hickmann tunneled central catheter (TCC). Three percent of cases developed catheter-related thrombosis in PICCs and no thrombosis in TCCs. Catheter-related bloodstream infection was diagnosed in 8% of patients. CVC occlusion occurred in 44 patients (88%). The total number of occlusion events was 128; 97% of patients with PICCs and 76% of patients with TCCs (p = 0.003). All patients reported that the use of CVC simplified their course of treatment. Most patients reported similar restrictions in activity associated with TCCs and PICCs. CONCLUSION The present study demonstrates that thrombosis and catheter-related bloodstream infections remain important complications of CVCs in AML patients. Occlusion rates were higher with the use of PICCs and the use of CVCs impacted the quality of life.
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Affiliation(s)
- Christi McKeown
- Division of Hematology-Oncology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, 5150 Center Ave, Suite 564, Pittsburgh, PA, 15232, USA
| | - Asha Ricciuti
- Division of Hematology-Oncology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, 5150 Center Ave, Suite 564, Pittsburgh, PA, 15232, USA
| | - Mounzer Agha
- Division of Hematology-Oncology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, 5150 Center Ave, Suite 564, Pittsburgh, PA, 15232, USA
| | - Anastasios Raptis
- Division of Hematology-Oncology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, 5150 Center Ave, Suite 564, Pittsburgh, PA, 15232, USA
| | - Jing-Zhou Hou
- Division of Hematology-Oncology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, 5150 Center Ave, Suite 564, Pittsburgh, PA, 15232, USA
| | - Rafic Farah
- Division of Hematology-Oncology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, 5150 Center Ave, Suite 564, Pittsburgh, PA, 15232, USA
| | - Robert L Redner
- Division of Hematology-Oncology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, 5150 Center Ave, Suite 564, Pittsburgh, PA, 15232, USA
| | - Annie Im
- Division of Hematology-Oncology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, 5150 Center Ave, Suite 564, Pittsburgh, PA, 15232, USA
| | - Kathleen A Dorritie
- Division of Hematology-Oncology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, 5150 Center Ave, Suite 564, Pittsburgh, PA, 15232, USA
| | - Alison Sehgal
- Division of Hematology-Oncology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, 5150 Center Ave, Suite 564, Pittsburgh, PA, 15232, USA
| | - James Rossetti
- Division of Hematology-Oncology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, 5150 Center Ave, Suite 564, Pittsburgh, PA, 15232, USA
| | - Konstantinos Lontos
- Division of Hematology-Oncology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, 5150 Center Ave, Suite 564, Pittsburgh, PA, 15232, USA
| | - Dana H Bovbjerg
- Division of Hematology-Oncology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, 5150 Center Ave, Suite 564, Pittsburgh, PA, 15232, USA
| | - Daniel Normolle
- Division of Hematology-Oncology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, 5150 Center Ave, Suite 564, Pittsburgh, PA, 15232, USA
| | - Michael Boyiadzis
- Division of Hematology-Oncology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, 5150 Center Ave, Suite 564, Pittsburgh, PA, 15232, USA.
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