HIGH-DOSE CORTICOSTEROID ASSOCIATED WITH CATHETER-RELATED THROMBOSIS AFTER ALLOGENEIC HAEMATOPOIETIC STEM CELL TRANSPLANTATION
(Abstract release date: 05/21/15)
EHA Library. Su Y. 06/12/15; 103104; S145
Disclosure(s): Peking University People’s HospitalPeking University Institute of Hematology
Prof. Yan Su
Contributions
Contributions
Abstract
Abstract: S145
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:30 to 12.06.2015 12:45
Location: Room Stolz 1
Background
Allogeneic haematopoietic stem cell transplantation (Allo-HSCT) recipients are at increased risk of thrombotic complications, most of which are catheter related. Catheter-related thrombosis (CRT) remains challenging in allo-HSCT patients. On one hand, the incidence of CRT varies considerably depending on clinical factors. CRT has major consequences for patients who are already vulnerable, including pulmonary embolism. On the other hand, the benefit of anticoagulation must be weighed against the substantially increased risk of bleeding. However, the underlying pathogenesis of CRT remains unclear. From a clinical perspective, it would be helpful to identify the risk factor of CRT in allo-HSCT patients.
Aims
The aim of this study was to examine the incidence and risk factors of CRT in allo-HSCT recipients.
Methods
We performed a retrospective nested case-control study in patients following allo-HSCT. Patients were reviewed retrospectively from all recipients who underwent allo-HSCT between July 2007 and June 2014 at Peking University People’s Hospital, Beijing. Transplantation protocols (donor selection, HLA typing, stem cell harvesting, conditioning therapy, and GVHD prophylaxis) were conducted according to our previously protocols. Thrombotic episodes were diagnosed based on the clinical suspicion of the physician (pain, swelling, etc.) with subsequent central venous catheter (CVC) or peripherally inserted central catheter (PICC) thrombosis confirmed by duplex ultrasound. Cases with CRT and controls were matched for time of HSCT (± 5 days), age at HSCT (±5 years) and type of insertion (CVCs or PICC).
Results
During the 6-year period, CVC and PICC were placed in 923 patients undergoing allo-HSCT. A total of 38 patients (4.11%) developed catheter-related thrombosis, among which 12 were associated with CVCs, and 26 were associated with PICCs. The median duration from catheter insertion to thrombosis was 97 days. Among patients with CRT, 20 patients were classified as high risk before transplantation, and 7 experienced relapse. On average, patients received 4.5 rounds of pre-HSCT chemotherapy. Despite reports of an association between thrombosis and infection, no patient with CRT experienced a central line-associated bloodstream infection in our study. No significant differences were noted in terms of primary disease, donor type, conditioning regimen and catheter type between cases and controls. On univariate analysis, high-risk classification and relapse were associated with CRT. Grade III-IV GVHD is strongly correlated with CRT. Exposure to high-dose corticosteroids and cyclophosphamide is also related to thrombotic complications. No correlations between CRT and blood counts, coagulation markers, hyperlipidaemia or hypoalbuminaemia were noted in the laboratory values analysed. Multivariate regression analysis identified grade III-IV GVHD and exposure to high-dose corticosteroids as independent risk factors for the development of catheter-related thrombosis after allo-HSCT.
Summary
In conclusion, we demonstrate that CRT occurs among patients following allo-HSCT. The use of high-dose corticosteroids is correlated with the onset of CRT. However, the efficacy and safety of thromboprophylaxis in this population requires further discussion.
Keyword(s): Allogeneic hematopoietic stem cell transplant, Catheter-related thrombosis, Corticosteroids
Session topic: Thrombosis and vascular biology
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:30 to 12.06.2015 12:45
Location: Room Stolz 1
Background
Allogeneic haematopoietic stem cell transplantation (Allo-HSCT) recipients are at increased risk of thrombotic complications, most of which are catheter related. Catheter-related thrombosis (CRT) remains challenging in allo-HSCT patients. On one hand, the incidence of CRT varies considerably depending on clinical factors. CRT has major consequences for patients who are already vulnerable, including pulmonary embolism. On the other hand, the benefit of anticoagulation must be weighed against the substantially increased risk of bleeding. However, the underlying pathogenesis of CRT remains unclear. From a clinical perspective, it would be helpful to identify the risk factor of CRT in allo-HSCT patients.
Aims
The aim of this study was to examine the incidence and risk factors of CRT in allo-HSCT recipients.
Methods
We performed a retrospective nested case-control study in patients following allo-HSCT. Patients were reviewed retrospectively from all recipients who underwent allo-HSCT between July 2007 and June 2014 at Peking University People’s Hospital, Beijing. Transplantation protocols (donor selection, HLA typing, stem cell harvesting, conditioning therapy, and GVHD prophylaxis) were conducted according to our previously protocols. Thrombotic episodes were diagnosed based on the clinical suspicion of the physician (pain, swelling, etc.) with subsequent central venous catheter (CVC) or peripherally inserted central catheter (PICC) thrombosis confirmed by duplex ultrasound. Cases with CRT and controls were matched for time of HSCT (± 5 days), age at HSCT (±5 years) and type of insertion (CVCs or PICC).
Results
During the 6-year period, CVC and PICC were placed in 923 patients undergoing allo-HSCT. A total of 38 patients (4.11%) developed catheter-related thrombosis, among which 12 were associated with CVCs, and 26 were associated with PICCs. The median duration from catheter insertion to thrombosis was 97 days. Among patients with CRT, 20 patients were classified as high risk before transplantation, and 7 experienced relapse. On average, patients received 4.5 rounds of pre-HSCT chemotherapy. Despite reports of an association between thrombosis and infection, no patient with CRT experienced a central line-associated bloodstream infection in our study. No significant differences were noted in terms of primary disease, donor type, conditioning regimen and catheter type between cases and controls. On univariate analysis, high-risk classification and relapse were associated with CRT. Grade III-IV GVHD is strongly correlated with CRT. Exposure to high-dose corticosteroids and cyclophosphamide is also related to thrombotic complications. No correlations between CRT and blood counts, coagulation markers, hyperlipidaemia or hypoalbuminaemia were noted in the laboratory values analysed. Multivariate regression analysis identified grade III-IV GVHD and exposure to high-dose corticosteroids as independent risk factors for the development of catheter-related thrombosis after allo-HSCT.
Summary
In conclusion, we demonstrate that CRT occurs among patients following allo-HSCT. The use of high-dose corticosteroids is correlated with the onset of CRT. However, the efficacy and safety of thromboprophylaxis in this population requires further discussion.
Keyword(s): Allogeneic hematopoietic stem cell transplant, Catheter-related thrombosis, Corticosteroids
Session topic: Thrombosis and vascular biology
Abstract: S145
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:30 to 12.06.2015 12:45
Location: Room Stolz 1
Background
Allogeneic haematopoietic stem cell transplantation (Allo-HSCT) recipients are at increased risk of thrombotic complications, most of which are catheter related. Catheter-related thrombosis (CRT) remains challenging in allo-HSCT patients. On one hand, the incidence of CRT varies considerably depending on clinical factors. CRT has major consequences for patients who are already vulnerable, including pulmonary embolism. On the other hand, the benefit of anticoagulation must be weighed against the substantially increased risk of bleeding. However, the underlying pathogenesis of CRT remains unclear. From a clinical perspective, it would be helpful to identify the risk factor of CRT in allo-HSCT patients.
Aims
The aim of this study was to examine the incidence and risk factors of CRT in allo-HSCT recipients.
Methods
We performed a retrospective nested case-control study in patients following allo-HSCT. Patients were reviewed retrospectively from all recipients who underwent allo-HSCT between July 2007 and June 2014 at Peking University People’s Hospital, Beijing. Transplantation protocols (donor selection, HLA typing, stem cell harvesting, conditioning therapy, and GVHD prophylaxis) were conducted according to our previously protocols. Thrombotic episodes were diagnosed based on the clinical suspicion of the physician (pain, swelling, etc.) with subsequent central venous catheter (CVC) or peripherally inserted central catheter (PICC) thrombosis confirmed by duplex ultrasound. Cases with CRT and controls were matched for time of HSCT (± 5 days), age at HSCT (±5 years) and type of insertion (CVCs or PICC).
Results
During the 6-year period, CVC and PICC were placed in 923 patients undergoing allo-HSCT. A total of 38 patients (4.11%) developed catheter-related thrombosis, among which 12 were associated with CVCs, and 26 were associated with PICCs. The median duration from catheter insertion to thrombosis was 97 days. Among patients with CRT, 20 patients were classified as high risk before transplantation, and 7 experienced relapse. On average, patients received 4.5 rounds of pre-HSCT chemotherapy. Despite reports of an association between thrombosis and infection, no patient with CRT experienced a central line-associated bloodstream infection in our study. No significant differences were noted in terms of primary disease, donor type, conditioning regimen and catheter type between cases and controls. On univariate analysis, high-risk classification and relapse were associated with CRT. Grade III-IV GVHD is strongly correlated with CRT. Exposure to high-dose corticosteroids and cyclophosphamide is also related to thrombotic complications. No correlations between CRT and blood counts, coagulation markers, hyperlipidaemia or hypoalbuminaemia were noted in the laboratory values analysed. Multivariate regression analysis identified grade III-IV GVHD and exposure to high-dose corticosteroids as independent risk factors for the development of catheter-related thrombosis after allo-HSCT.
Summary
In conclusion, we demonstrate that CRT occurs among patients following allo-HSCT. The use of high-dose corticosteroids is correlated with the onset of CRT. However, the efficacy and safety of thromboprophylaxis in this population requires further discussion.
Keyword(s): Allogeneic hematopoietic stem cell transplant, Catheter-related thrombosis, Corticosteroids
Session topic: Thrombosis and vascular biology
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:30 to 12.06.2015 12:45
Location: Room Stolz 1
Background
Allogeneic haematopoietic stem cell transplantation (Allo-HSCT) recipients are at increased risk of thrombotic complications, most of which are catheter related. Catheter-related thrombosis (CRT) remains challenging in allo-HSCT patients. On one hand, the incidence of CRT varies considerably depending on clinical factors. CRT has major consequences for patients who are already vulnerable, including pulmonary embolism. On the other hand, the benefit of anticoagulation must be weighed against the substantially increased risk of bleeding. However, the underlying pathogenesis of CRT remains unclear. From a clinical perspective, it would be helpful to identify the risk factor of CRT in allo-HSCT patients.
Aims
The aim of this study was to examine the incidence and risk factors of CRT in allo-HSCT recipients.
Methods
We performed a retrospective nested case-control study in patients following allo-HSCT. Patients were reviewed retrospectively from all recipients who underwent allo-HSCT between July 2007 and June 2014 at Peking University People’s Hospital, Beijing. Transplantation protocols (donor selection, HLA typing, stem cell harvesting, conditioning therapy, and GVHD prophylaxis) were conducted according to our previously protocols. Thrombotic episodes were diagnosed based on the clinical suspicion of the physician (pain, swelling, etc.) with subsequent central venous catheter (CVC) or peripherally inserted central catheter (PICC) thrombosis confirmed by duplex ultrasound. Cases with CRT and controls were matched for time of HSCT (± 5 days), age at HSCT (±5 years) and type of insertion (CVCs or PICC).
Results
During the 6-year period, CVC and PICC were placed in 923 patients undergoing allo-HSCT. A total of 38 patients (4.11%) developed catheter-related thrombosis, among which 12 were associated with CVCs, and 26 were associated with PICCs. The median duration from catheter insertion to thrombosis was 97 days. Among patients with CRT, 20 patients were classified as high risk before transplantation, and 7 experienced relapse. On average, patients received 4.5 rounds of pre-HSCT chemotherapy. Despite reports of an association between thrombosis and infection, no patient with CRT experienced a central line-associated bloodstream infection in our study. No significant differences were noted in terms of primary disease, donor type, conditioning regimen and catheter type between cases and controls. On univariate analysis, high-risk classification and relapse were associated with CRT. Grade III-IV GVHD is strongly correlated with CRT. Exposure to high-dose corticosteroids and cyclophosphamide is also related to thrombotic complications. No correlations between CRT and blood counts, coagulation markers, hyperlipidaemia or hypoalbuminaemia were noted in the laboratory values analysed. Multivariate regression analysis identified grade III-IV GVHD and exposure to high-dose corticosteroids as independent risk factors for the development of catheter-related thrombosis after allo-HSCT.
Summary
In conclusion, we demonstrate that CRT occurs among patients following allo-HSCT. The use of high-dose corticosteroids is correlated with the onset of CRT. However, the efficacy and safety of thromboprophylaxis in this population requires further discussion.
Keyword(s): Allogeneic hematopoietic stem cell transplant, Catheter-related thrombosis, Corticosteroids
Session topic: Thrombosis and vascular biology
{{ help_message }}
{{filter}}