Paper: Management of Catheter-Related Thrombosis in Patients Undergoing Autologous Stem Cell Transplantation

Poster Abstracts

Grand Hall CD (Manchester Grand Hyatt)

Manish Sharma, MD , Medical oncology, Thomas Jefferson University, Philadelphia, PA

Mahasweta Gooptu, MD , Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA

Thomas Klumpp, MD , Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA

Neeraj Saini, MD , Medical Oncology, Thomas Jefferson University, Philadelphia, PA

Ashok Mandala, MD , Medical Oncology, Thomas Jefferson University, Philadelphia, PA

Sherilyn Tuazon, MD , Medical Oncology, Thomas Jefferson University, Philadelphia, PA

Srikanth Nagalla, MD , Thomas Jefferson University, Philadelphia, PA

John Wagner, MD , Medical Oncology, Thomas Jefferson University, Philadelphia, PA

Margaret Kasner, MD , Medical Oncology, Thomas Jefferson University, Philadelphia, PA

Onder Alpdogan, MD , Medical Oncology, Thomas Jefferson University, Philadelphia, PA

Ubaldo Martinez, MD , Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA

Dolores Grosso, DNP , Medical Oncology, Thomas Jefferson University, Philadelphia, PA

Joanne Filicko, MD , Thomas Jefferson University Hospital, Philadelphia, PA

Barbara Pro, MD , Medical Oncology, Thomas Jefferson University, Philadelphia, PA

Matthew Carabasi, MD , Medical Oncology, Thomas Jefferson University, Philadelphia, PA

Neal Flomenberg, MD , Medical Oncology, Thomas Jefferson University, Philadelphia, PA

Mark Weiss, MD , Medical Oncology, Thomas Jefferson University, Philadelphia, PA

Presentation recording not available for download or distribution as requested by the presenting author.

Introduction:

The optimal management of catheter-related thrombosis (CRT) in patients undergoing autologous stem-cell transplantation (ASCT) remains poorly defined. We reviewed the management of catheter-related thrombosis in ASCT patients in our transplant unit over an 8-year period.

Methods:

We reviewed all patients undergoing ASCT at Thomas Jefferson University from 2006-2013. Patients with previous history of venous thrombosis receiving anticoagulation at ASCT were excluded. Patients with CRT were identified and management was reviewed. Three populations were identified: No CRT, CRT no anticoagulation, and CRT on anticoagulation. We performed a Wilcoxon Ranks Sum analysis to evaluate blood and platelet utilization in the three groups. We also reviewed major bleeding events (MBE) and secondary thrombotic events (pulmonary embolism, PE).

Results:

We identified 214 patients as described in Table 1. The incidence of CRT for the whole group was 11.2%. Of the 24 patients with CRT, 46% were treated with AC and the remaining was observed without AC. The median number of pooled platelets transfused was 14 in the CRT + AC group, 4 in the no CRT and 4 CRT with no anticoagulation groups (p=0.02). The median number of PRBC transfusions in the no CRT, CRT + AC, and CRT with no AC groups was, 2, 4, and 2, respectively (p=0.01). None of the patients with CRT developed a second thrombotic event (PE). Incidence of major bleeding within the CRT + AC group was 27% while in the CRT and no AC group was 15% (p=NS). One patient expired due to the result of a subarachnoid hemorrhage.

Conclusions:

A strategy utilizing AC for CRT in the setting of an autologous transplant results in increased utilization of both platelet and PRBC transfusion and is associated with a trend towards a higher risk of major bleeding. There was no difference in the incidence of PE following CRT in patients treated with or without AC in this small cohort of ASCT patients.

Table 1: Patient Characteristics

No CRT

CRT + Anticoagulation

CRT with no anticoagulation

Number of patients

190

11

13

Median age at transplant (year)

58

62

60

Male gender

116

6

10

Ethnicity:
Caucasian
African
Asian
Hispanic
Other/Unknown

122
47
7
6
8

7
2
0
2
0

12
1
0
0
0

Mailgnancy:
Myeloma
Non-Hodgkins' lymphoma
Hodgkins' lymphoma
Primary amyloidosis
CLL
AML
APML
Other

132
34
12
3
2
2
1
4

8
2
0
1
0
0
0
0

8
3
0
2
0
0
0
0

Conditioning:
Melphalan alone
BEAM
Busulfan/Cyclophosphamide
Cyclophosphamide alone
Unknown

135
48
2
4
1

9
2
0
0
0

10
3
0
0
0

Neutrophil engraftment (in days)

11

12

12

Platelet engraftment (in days)

15

17

17

Table 2: Outcome analysis

No CRT

CRT + Anticoagulation

CRT with no anticoagulation

p-value

Platelet utilization (Number of pooled platelet units)

4

14

4

0.02

PRBC cell utilization (Number of PRBC transfusions)

2

4

2

0.01

Disclosures:

Nothing To Disclose

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Table 1: Patient Characteristics
	No CRT	CRT + Anticoagulation	CRT with no anticoagulation
Number of patients	190	11	13
Median age at transplant (year)	58	62	60
Male gender	116	6	10
Ethnicity: Caucasian African Asian Hispanic Other/Unknown	122 47 7 6 8	7 2 0 2 0	12 1 0 0 0
Mailgnancy: Myeloma Non-Hodgkins' lymphoma Hodgkins' lymphoma Primary amyloidosis CLL AML APML Other	132 34 12 3 2 2 1 4	8 2 0 1 0 0 0 0	8 3 0 2 0 0 0 0
Conditioning: Melphalan alone BEAM Busulfan/Cyclophosphamide Cyclophosphamide alone Unknown	135 48 2 4 1	9 2 0 0 0	10 3 0 0 0
Neutrophil engraftment (in days)	11	12	12
Platelet engraftment (in days)	15	17	17

Table 2: Outcome analysis
	No CRT	CRT + Anticoagulation	CRT with no anticoagulation	p-value
Platelet utilization (Number of pooled platelet units)	4	14	4	0.02
PRBC cell utilization (Number of PRBC transfusions)	2	4	2	0.01

346 Management of Catheter-Related Thrombosis in Patients Undergoing Autologous Stem Cell Transplantation