The incidence of symptomatic catheter-related thrombosis in patients with multiple myeloma (MM) undergoing autologous stem cell transplantation (ASCT) appears to be low, according to research published in Medicina. The study also reported risk factor of catheter-related thrombosis in this patient population.
“Multiple myeloma carries one of the highest risks of [cancer associated thrombosis], especially in the early phases of treatment,” the investigators wrote. “Autologous stem cell transplantation as the standard of care in transplant-eligible patients with MM carries a risk of catheter-related thrombosis.”
The researchers aimed to identify risk factors associated with catheter-related thrombosis in patients with MM undergoing ASCT. They retrospectively analyzed patients with MM undergoing ASCT between 2009 and 2019 at the Department of Hematology and Bone Marrow Transplantation of Poznan University of Medical Sciences in Poznan, Poland.
Prior to ASCT, all patients had a central venous catheter (CVC) inserted. In patients who presented clinical symptoms of catheter-related thrombosis (such as edema, redness, pain in the CVC insertion area), thrombosis was confirmed using Doppler ultrasound. The researchers examined the association of groups of patient-related, disease-related, treatment-related, and CVC-related factors with catheter-related thrombosis.
A total of 276 patients (median age, 58 years; IQR, 53-64) with MM undergoing ASCT were included in the study. Among all patients, 2.5% (n=7) developed symptomatic catheter-related thrombosis. Most cases (6 of 7) occurred during hospitalization, and in all cases, the thrombosis occurred with right-side access. Among patients with catheter-related thrombosis, the median age at the time of the event was 63 years (IQR, 56-66).
With univariate analyses, the investigators found an increased risk of catheter-related thrombosis in patients with a catheter-related infection (odds ratio [OR], 2.4; 95% CI, 1.109-5.19; P =.026), previous thrombotic episode (OR, 2.49; 95% CI; 1.15-5.39; P =.021), previous thrombotic episode on initial myeloma treatment (OR, 2.75; 95% CI, 1.15-6.53; P =.022), and gastrointestinal complications of ASCT (OR, 3.87; 95% CI, 1.57-9.53; P =.003). With multivariate analysis, they found an association between noninfectious complications and higher catheter-related thrombosis incidence (OR, 2.75; 95% CI, 1.10-6.19; P =.031).
The primary limitations of the study included the retrospective design and associated nonstandardization of documentation, treatment and follow up, lack of racial diversity in the study population, and analysis of only symptomatic catheter-related thrombosis events.
“The incidence of symptomatic [catheter-related thrombosis] in ASCT in MM was relatively low,” the investigators wrote. “Previous thrombotic events, especially during the induction of myeloma treatment, increased [catheter-related thrombosis] risk during ASCT, [and] dehydration following gastrointestinal complications may predispose to higher [catheter-related thrombosis] incidence.”
Hoppe A, Rupa-Matysek J, Małecki B, Dytfeld D, Hoppe K, Gil L. Risk factors for catheter-related thrombosis in multiple myeloma patients undergoing autologous stem cell transplantation. Medicina (Kaunas). 2021;57(10):1020. doi:10.3390/medicina57101020