Catheter-Related Complications in Acute Myeloid Leukemia Patients After Hematopoietic Stem Cell Transplant

Background: Intravenous catheters are widely used in hematopoietic stem cell transplant (HSCT) patients. Complications associated with these catheters are frequently encountered and contribute to morbidity, mortality, and increased cost of treatment. Studies exploring such complications in this unique patient population are lacking. We retrospectively studied infectious and thrombotic catheter-related complications in acute myeloid leukemia (AML) patients after undergoing HSCT at the largest tertiary referral center in Oklahoma. Methods: AML patients above the age of 18 who had HSCT at The University of Oklahoma Health Sciences Center between January, 2000 and June, 2012 were identified and medical records were reviewed. Patients were stratified according to age, first HSCT type and type of catheter(s) present at or after the first HSCT (Hickman, peripherally inserted central catheter (PICC) or infusion port (IP)). First blood stream infection (BSI) and deep venous thrombosis (DVT) events after the first HSCT were reported (subsequent events were not included). Statistical analysis was performed using SAS 9.2 software (SAS Institute Inc.). Fisher’s exact test was used to compare patients in the different groups. Results: 62 patients were included. Median age at diagnosis was 44 years. 42 (68%) were males and 20 (32%) were females. 53 (87%) were White, 4 (7%) Native American and 3 (5%) African American. 26 (43%) had sibling (SIB), 22 (36%) unrelated donor (URD) and 13 (21%) double cord blood (DCB) transplant. 56 (93%) had Hickman, 30 (50%) PICC and 7 (12%) IP. 28 patients had one catheter type only (24 Hickman and 4 PICC). BSI occurred in 37% of all cases. BSI rates according to the presence or absence of a particular catheter type were 38% vs. 33% for Hickman, 37% vs. 38% for PICC and 43% vs. 36% for IP. In patients with only one catheter type, BSI rates were 38% for Hickman vs. 50% for PICC (p=0.9). BSI occurred in 40% of patients 50 years of age or younger and in 29% of those >50 years (p=0.56). Patients with DCB transplant had 63% infections vs. 31% in the other transplant types (p=0.059). Gram-positive cocci were isolated in 57% and Gram-negative rods in 26% of all infections. DVT occurred in 26% of all cases. DVT rates according to the presence or absence of a particular catheter type were 27% vs. 25% for Hickman, 37% vs. 17% for PICC (p=0.1) and 14% vs. 29% for IP (p=0.6). In patients with only one catheter type, DVT rates were 17% for Hickman vs. 25% for PICC (p=0.4). DVT occurred in 18% of patients 50 years of age or younger and in 47% of those >50 years (p=0.026). Conclusion: Among AML patients who underwent HSCT at our institution, we did not observe any significant differences in catheter-related complications according to catheter type. DVT rate was significantly higher in patients older than 50 years. There was a trend of higher infection rate with double cord blood transplant compared to other transplant types.