PICC‐RELATED THROMBOSIS IN PATIENTS WITH AGGRESSIVE LYMPHOMA TREATED WITH DA‐EPOCH—HOW TO PREVENT IT?

Abstract

Introduction: Peripherally inserted central catheters (PICCs) are long-term catheters appropriate for administration of continuous infusions such as DA-EPOCH protocol. The main complications associated with PICC-lines are infections and PICC-related thrombosis. Data on the incidence and prevention of PICC-related thrombosis in patients with lymphoma are limited. In this study, we investigated the role of antithrombotic prophylaxis in patients with aggressive non-Hodgkin lymphoma (NHL) treated with DA-EPOCH ± rituximab (DA-EPOCH ± R). Methods: From September 2009 to March 2017, 95 patients with newly diagnosed aggressive NHL were treated with DA-EPOCH ± R regimen at our institution. A single lumen 5Fr PICC was used in all patients. Antithrombotic prophylaxis was given per treating physician discretion, starting from the day of PICC insertion. Dalteparin 2500 to 5000 IU or enoxaparine sodium 4000 IU qD were used as low molecular weight heparin (LMWH) prophylaxis. Two-tailed Fisher's test was used for comparison and the P value of less than 0.05 was considered significant. Results: There were 55 males and 40 females with a median age of 62 years (range 21–82 y). Eight patients had T-cell lymphoma, and 88 had B-cell NHL. Nine patients had PICC-related thrombosis (9.5% of all patients). Six patients developed PICC-related thrombosis during the first cycle, one during the second cycle, and two during the third cycle of DA-EPOCH ± R. All events occurred in the group of 68 patients who did not receive antithrombotic prophylaxis/treatment (incidence 13.2%). Antithrombotic prophylaxis was given in 17 (18%) patients: ten patients received low-dose LMWH for prophylaxis for one or two cycles of DA-EPOCH ± R, and seven patients received Aspirin 100 mg for prophylaxis. In additional ten patients, full-dose LMWH was given for deep vein thrombosis at presentation and continued in prophylactic dose. None of the patients that received prophylaxis/treatment developed PICC-related thrombosis (0/27). However, this result did not reach the level of statistical significance (P = 0.056). There was no hemorrhage related to antithrombotic treatment/prophylaxis. Conclusions: The incidence of PICC-related thrombosis in patients without antithrombotic prophylaxis was 13.2%, and two-thirds occurred during the first cycle. In contrast, the patients who received any type of antithrombotic prophylaxis or treatment had no PICC-related thrombosis. Although the level of statistical significance has not been reached (P = 0.056), our results suggest that patients with aggressive lymphoma may benefit from the prophylaxis with low-dose LMWH during the first two cycles of DA-EPOCH ± R. Keywords: DA-R-EPOCH; EPOCH; non-Hodgkin lymphoma (NHL).