Risk Factors for Catheter-Related Thrombosis in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation

Abstract

Background and Objectives: Cancer associated thrombosis (CAT) is a common complication of neoplasms. Multiple myeloma (MM) carries one of the highest risks of CAT, especially in the early phases of treatment. Autologous stem cell transplantation (ASCT) as the standard of care in transplant-eligible patients with MM carries a risk of catheter-related thrombosis (CRT). The aim of this study was identification of the risk factors of CRT in MM patients undergoing ASCT in 2009–2019. Materials and Methods: We retrospectively analyzed patients with MM undergoing ASCT. Each patient had central venous catheter (CVC) insertion before the procedure. The clinical symptoms of CRT (edema, redness, pain in the CVC insertion area) were confirmed with Doppler ultrasound examination. We examined the impacts of four groups of factors on CRT development: (1) patient-related: age, gender, Body Mass Index (BMI), obesity, Charlson comorbidity index, hematopoietic stem cell transplantation comorbidity index, renal insufficiency, and previous thrombotic history; (2) disease-related: monoclonal protein type, stage of the disease according to Salmon–Durie and International Staging System, number of prior therapy lines, and MM response before ASCT; (3) treatment-related: melphalan dose, transplant-related complications, and duration of post-ASCT neutropenia; (4) CVC-related: location, time from placement to removal. Results: Symptomatic CRT was present in 2.5% (7/276) of patients. Univariate analysis showed an increased risk of CRT in patients with a catheter-related infection (OR 2.4, 95% CI; 1.109–5.19, p = 0.026), previous thrombotic episode (OR 2.49, 95% CI; 1.15–5.39, p = 0.021), previous thrombotic episode on initial myeloma treatment (OR 2.75, 95% CI; 1.15–6.53, p = 0.022), and gastrointestinal complications of ASCT such as vomiting and diarrhea (OR 3.87, 95% CI; 1.57–9.53, p = 0.003). In multivariate analysis, noninfectious complications were associated with higher CRT incidence (OR 2.75, 95% CI; 1.10–6.19, p = 0.031). Conclusions: The incidence of symptomatic CRT in ASCT in MM was relatively low. Previous thrombotic events, especially during the induction of myeloma treatment, increased CRT risk during ASCT. Dehydration following gastrointestinal complications may predispose to higher CRT incidence.

An Update on Hematopoietic Stem Cell Transplantation in Patients with Multiple Myeloma

“…Early complications occur before day 100 post-HSCT, while late complications are usually encountered after day 100 posttransplantation. The early and late complications are shown in Table 3 [167][168][169][170][171][172][173][174][175][176][177][178][179][180][181][182] and Table 4 [183][184][185][186][187][188], respectively. The predisposing factors for the complications of autologous HSCT in patients with MM include: (1) the disease itself; (2) presence of other comorbid medical conditions; (3) old age; (4) renal failure; and (5) drugs used in the treatment of patients with MM such as: corticosteroids, cyclophosphamide, HD melphalan, thalidomide, lenalidomide use before and after HSCT, as well as…”

Risk of Venous Thromboembolism in Multiple Myeloma Patients During the Immediate Peri-Autologous Hematopoietic Cell Transplantation Phase

“… 4 , 5 Those undergoing autologous hematopoietic cell transplant (AHCT) are at further enhanced risk. 6 - 9 Here, we explored the dynamics of VTE in their peri-AHCT setting, defined as extending from hematopoietic progenitor cell (HPC) mobilization up to 30 days post-AHCT. Chi-square and t -tests were performed for univariate analysis of categorical and continuous variables, respectively.…”