High-dose corticosteroid associated with catheter-related thrombosis after allogeneic hematopoietic stem cell transplantation.
BACKGROUND
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients are at an increased risk of thrombotic complications, most of which are catheter-related and present a substantial challenge. The incidence of CRT varies considerably depending on clinical factors. However, the underlying pathogenesis and risk factors remain unclear.


METHODS
We performed a retrospective nested case-control study in patients following allo-HSCT. Thrombotic episodes were diagnosed based on the clinical suspicion of the physician (pain, swelling, etc.) with subsequent CVC or PICC thrombosis confirmed via duplex ultrasound. Cases with CRT and controls were matched for time of HSCT, age at HSCT, donor source and type of insertion (CVCs or PICC).


RESULTS
During the 8-year period, catheters were placed in 2896 patients, with a total of 40 patients (1.38%) developed CRT, among which 11 were associated with CVCs and 29 were associated with PICCs. The median duration from catheter insertion to thrombosis was 97days. Despite reports of an association between thrombosis and infection, central line-associated bloodstream infection was comparable between groups. No significant differences were noted in terms of primary disease, donor type, conditioning regimen or catheter type between the cases and controls. A multivariate regression analysis identified high-dose corticosteroids as independent risk factors for the development of CRT. CRT seems to negatively affect prognosis in allo-HSCT patients.


CONCLUSIONS
In conclusion, we demonstrate that the use of high-dose corticosteroids is correlated with the onset of CRT. However, the efficacy and safety of thromboprophylaxis in this population require further investigation.
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Xiao-Hui
XH
Zhang
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Fei-Er
FE
Feng
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Wei
W
Han
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Feng-Rong
FR
Wang
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Jing-Zhi
JZ
Wang
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Yu
Y
Wang
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Yao
Y
Chen
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Hai-Xia
HX
Fu
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Xiao-Dong
XD
Mo
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Yuan-Yuan
YY
Zhang
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Chen-Hua
CH
Yan
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Huan
H
Chen
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Yu-Hong
YH
Chen
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Yang
Y
Liu
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Lan-Ping
LP
Xu
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Kai-Yan
KY
Liu
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University. No. 11 Xizhimen South Street, Xicheng District, Beijing, China. Electronic address: huangxj_pkuph@sina.com.
Xiao-Jun
XJ
Huang
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D016022:Case-Control Studies; D002404:Catheterization / Q000009:adverse effects; D057785:Catheters / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology*; D014184:Transplantation, Homologous / Q000009:adverse effects; D055815:Young Adult
D000305:Adrenal Cortex Hormones
Allogeneic hematopoietic stem cell transplantation; Catheter-related thrombosis; Corticosteroids