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A prediction model for central venous catheter-related thrombosis in patients with newly-diagnosed acute myeloid leukemia: A derivation cohort analysis

  • Shay Perek
    Affiliations
    Department of Internal Medicine A, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel

    Department of Emergency Medicine, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel

    The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, 1, Efron St, Haifa 3109601, Israel
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  • Alaa Khatib
    Affiliations
    Department of Emergency Medicine, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel
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  • Niv Izhaki
    Affiliations
    Department of Internal Medicine A, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel
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  • Ali Sleman Khalaila
    Affiliations
    Department of Internal Medicine, Nazareth Hospital EMMS, 1611, Al Wadi Al Jawani, Nazareth 16100, Israel
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  • Benjamin Brenner
    Affiliations
    The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, 1, Efron St, Haifa 3109601, Israel

    Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel
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  • Netanel A. Horowitz
    Correspondence
    Corresponding author at: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel.
    Affiliations
    The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, 1, Efron St, Haifa 3109601, Israel

    Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel
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      Highlights

      • In newly diagnosed AML patients the catheter-related thrombosis (CRT) rate was >10%.
      • The study proposes simple models for CRT prediction in AML patients at diagnosis.
      • Acute promyelocytic leukemia (APL), prior VTE, high BMI and platelet counts are key risk factors.
      • Chronic obstructive pulmonary disease arose as a new CRT risk factor in non-APL AML.
      • CRT events are not associated with higher morality in newly diagnosed AML patients.

      Abstract

      Background

      Catheter-related thrombosis (CRT) is a common complication in cancer patients, that may lead to chemotherapy deferral, elevated risk for systemic infections and pulmonary embolism. This study aimed to assess CRT incidence and risk factors in newly-diagnosed acute myeloid leukemia (AML) patients and create predictive models potentially allowing to decrease CRT occurrence in this population.

      Methods

      This retrospective single-center analysis included all AML patients treated at the Rambam Health Care Campus between 2006 and 2019. Patient clinical and laboratory data were collected to evaluate thrombosis occurrence and time from AML diagnosis to CRT development. Multivariate classification models were created using logistic regression (LR) and competing risk analyzes.

      Results

      The final analysis included 632 newly-diagnosed AML patients (mean age 54 ± 15 years). CRT incidence was 10.1% [confidence interval (CI) 7.7–12.9%], median time from AML diagnosis to CRT was 12.5 days [interquartile range 6–30]. In an LR multivariate model, prior history of venous thromboembolism [adjusted odds ratio (AOR) 12.046, p < 0.0001], acute promyelocytic leukemia (APL) (AOR 2.824, p = 0.015), a high body mass index and initial platelet counts <100 × 10E9/L (AOR 1.059 and 0.546; p = 0.011 and 0.040, respectively) were significantly associated with high CRT risk. Analysis of 587 non-APL patients demonstrated comparable results, with CRT incidence of 9.3% (CI 7.0%-12.1%) and emergence of chronic obstructive pulmonary disease (COPD) as a novel significant co-factor (AOR 34.491, p = 0.004). In both models, the area under curve (AUC) was ≥70%.

      Conclusions

      Significant CRT risk factors defined using the created model could be used for identification of high-risk newly-diagnosed AML patients requiring CRT prophylaxis.

      Keywords

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