Indwelling Pleural Catheters for Patients with Hematologic Malignancies. A 14-Year, Single-Center Experience.
BACKGROUND
Placement of an indwelling pleural catheter is an established modality for symptom relief and pleurodesis in the treatment of malignant pleural effusion. Concerns remain regarding possible infectious complications, risk of hemorrhage, and the rate of pleurodesis with the use of pleural catheters in the treatment of hematologic malignancies.


OBJECTIVE
The goals of our study were: (1) to evaluate the safety and cumulative incidence of pleurodesis with indwelling pleural catheters for patients with hematologic malignancies, and (2) to evaluate overall survival of this cohort of patients with pleural effusions.


METHODS
We performed a retrospective review of 172 patients with a hematologic malignancy who underwent placement of an indwelling pleural catheter between September 1997 and August 2011 at the University of Texas MD Anderson Cancer Center in Houston, Texas. A competing risk model analysis was used for complications and pleurodesis. Analysis was based on each patient's first intrapleural catheter.


RESULTS
There were 172 patients with lymphoma (58%), acute (16%) or chronic leukemia (16%), or multiple myeloma (10%). The effusions were characterized as malignant (85.5%), infectious (4.1%), volume overload (4.7%), or therapy-related (4.7%). Chylothorax was found in 20.1%. Pleural biopsies were obtained from 13 patients. The cumulative incidence of all complications was 13.6%, and the cumulative incidence of all significant catheter-related complications was 9.5%. The incidence of empyema was 2.9%, and major bleeding (requiring transfusion or intervention) was 1.7%. Thirty-day procedure-associated mortality was 0.6%. The cumulative incidence of pleurodesis at 180 days was 50%, with a median time to pleurodesis of 81 days for the entire cohort.


CONCLUSIONS
Indwelling pleural catheters appear to be safe for patients with hematologic malignancies. Complications and the cumulative incidence of pleurodesis are comparable to those reported for patients with solid organ malignancies.
1 Department of Pulmonary Medicine, and.
Saadia A
http://orcid.org/0000-0001-7284-3945
SA
Faiz
2 Division of Pulmonary, Critical Care Medicine, and Sleep Medicine, The University of Texas Health Science Center at Houston, Houston, Texas.
Priyanka
P
Pathania
3 Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Juhee
J
Song
3 Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Liang
L
Li
1 Department of Pulmonary Medicine, and.
Diwakar D
http://orcid.org/0000-0002-7427-9388
DD
Balachandran
1 Department of Pulmonary Medicine, and.
David E
http://orcid.org/0000-0001-6351-5552
DE
Ost
1 Department of Pulmonary Medicine, and.
Rodolfo C
RC
Morice
1 Department of Pulmonary Medicine, and.
Vickie R
http://orcid.org/0000-0002-5938-4841
VR
Shannon
1 Department of Pulmonary Medicine, and.
Lara
L
Bashoura
1 Department of Pulmonary Medicine, and.
Georgie A
http://orcid.org/0000-0001-6408-6964
GA
Eapen
1 Department of Pulmonary Medicine, and.
Carlos A
CA
Jimenez
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004322:Drainage / Q000009:adverse effects; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000473:pathology*; D016066:Pleural Effusion, Malignant / Q000453:epidemiology* / Q000209:etiology; D018700:Pleurodesis / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016019:Survival Analysis; D013781:Texas; D016896:Treatment Outcome; D055815:Young Adult
empyema; hematologic malignancies; indwelling pleural catheter; malignant pleural effusion; pleurodesis