CHEST
Volume 148, Issue 3, September 2015, Pages 752-758
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Original Research
Pulmonary Procedures
The Use of Indwelling Tunneled Pleural Catheters for Recurrent Pleural Effusions in Patients With Hematologic Malignancies: A Multicenter Study

https://doi.org/10.1378/chest.14-3119Get rights and content

BACKGROUND

Malignant pleural effusion is a common complication of advanced malignancies. Indwelling tunneled pleural catheter (IPC) placement provides effective palliation but can be associated with complications, including infection. In particular, hematologic malignancy and the associated immunosuppressive treatment regimens may increase infectious complications. This study aimed to review outcomes in patients with hematologic malignancy undergoing IPC placement.

METHODS

A retrospective multicenter study of IPCs placed in patients with hematologic malignancy from January 2009 to December 2013 was performed. Inclusion criteria were recurrent, symptomatic pleural effusion and an underlying diagnosis of hematologic malignancy. Records were reviewed for patient demographics, operative reports, and pathology, cytology, and microbiology reports.

RESULTS

Ninety-one patients (mean ± SD age, 65.4 ± 15.4 years) were identified from eight institutions. The mean X SD in situ dwell time of all catheters was 89.9 ± 127.1 days (total, 8,160 catheter-days). Seven infectious complications were identified, all of the pleural space. All patients were admitted to the hospital for treatment, with four requiring additional pleural procedures. Two patients died of septic shock related to pleural infection.

CONCLUSIONS

We present, to our knowledge, the largest study examining clinical outcomes related to IPC placement in patients with hematologic malignancy. An overall 7.7% infection risk and 2.2% mortality were identified, similar to previously reported studies, despite the significant immunosuppression and pancytopenia often present in this population. IPC placement appears to remain a reasonable clinical option for patients with recurrent pleural effusions related to hematologic malignancy.

Section snippets

Results

Ninety-one patients were identified from eight institutions between January 2009 and December 2013 (Table 1). No patients were excluded from subsequent analyses. The mean ± SD age within the cohort was 65.4 ± 15.4 years (range, 22-93 years). Malignancy was present in 96% (87 of 91 patients), with lymphoma being the most commonly identified malignancy (62%) followed by leukemia (21%) and multiple myeloma (13%). Four patients were classified as other (two with amyloidosis and two with

Discussion

We present, to our knowledge, the largest study to examine clinical outcomes related to the placement of IPCs for recurrent pleural effusion in patients with underlying hematologic malignancies. The mean time to IPC removal of all catheters within the cohort was 89.9 days, but in patients undergoing spontaneous pleurodesis the mean time to removal was 63.2 days. Univariate analysis was unable to identify clinical predictors of spontaneous pleurodesis within this cohort.

We identified a 7.7%

Acknowledgments

Author contributions: C. R. G. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. C. R. G. and L. Y. contributed to the data collection, data analysis, manuscript writing, and manuscript review; H. J. L. contributed to the data analysis, manuscript writing, and manuscript review; J. H. S., F. M., M. W., P. J. C., J. B., D. S., A. C. A., S. S., J. A. G., C. L. W., and D. F.-K. contributed to the data

References (18)

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FUNDING/SUPPORT: There was no funding available for the performance of this study. The use of the REDCap database was supported by the Penn State Clinical and Translational Research Institute; a University of Pennsylvania Clinical and Translational Research Award; and a National Institutes of Health, National Center for Research Resources [Grant UL1RR033184].

originally published Online First March 19, 2015.

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