Pb1883: implantation and long-term use of peripherally-inserted central catheter are safe in patients with acute promyelocytic leukaemia

Topic: 4. Acute myeloid leukemia - Clinical Background: At diagnosis, acute promyelocytic leukaemia (APL) is associated with high risk of bleeding complications due to coagulopathy and thrombocytopenia. In current guidelines, it is explicitly stated that the introduction of the central venous catheter should be avoided in this initial phase. However, patients absolutely need high-quality venous access for the administration of both antitumor and supportive treatment. A peripherally inserted central catheter (PICC) is a central venous catheter intended for medium to long-term use. Its implantation and use are safe in the hands of experienced personnel. We started the PICC implementation program at our institution in 2016. After gaining the necessary experience, we also started implanting this type of catheter in patients with acute leukaemia. Due to the lower risk of bleeding complications associated with implantation, we decided to prefer PICC in patients with APL as well. Aims: Retrospective analysis of a single institution experience with PICC implantation and use in all consecutive patients with newly diagnosed APL over the past 5 years. Methods: We have treated a total of 13 patients with newly diagnosed APL since 2017. A PICC was used in all of them from the beginning of the induction treatment. There were 8 women and 5 men with an median age of 60 (24-73) years. The first five patients were treated with a combination of ATRA and chemotherapy, the others according to the ATRA-ATO protocol. The selection of the treatment protocol was determined by the currently valid recommendation and reimbursement rules of the treatment within the framework of the health insurance. The PICC was usually implanted on the second day of hospitalization (7 patients), less often on the first day (3 patients). In the first two patients in the group, the implantation was performed on the 6th and 5th day, respectively. The punctured vein was the brachial or basilic vein in 10 cases, and the axillary vein (with longer subcutaneous tunnelling) in 3 patients. A 2-lumen 5F catheter was used more often (7 times – including in all 5 patients treated with chemotherapy), a 1-lumen 4F catheter was inserted 6 times. The median level of platelets at implantation was 55 (20 – 118) x 109/l. All patients had coagulopathy typical of APL. Results: In 7 patients, the catheter was used for the entire duration of the treatment and was extracted after its completion. The median duration of use was 202 (159-298) days. Three patients continue treatment with the catheter used 116, 151 and 262 days. In two patients, the catheter was extracted before the end of treatment. In the first patient of the group after 30 days for local inflammation at the entry site, in the seventh patient after 31 days due to fever of unknown origin. One patient died during induction treatment (ATRA/ATO) from respiratory failure caused by COVID-19 pneumonia. In addition to the above, we noticed only one more complication, which did not require catheter extraction. It was a short partial thrombosis of the vein around the catheter 26 days after implantation. None of the patients experienced complication during catheter implantation. Summary/Conclusion: Our 5-year experience suggests that in the hands of an experienced team, the PICC is a safe device providing long-term central venous access for the care of patients with acute promyelocytic leukaemia, including the most critical initial phase of treatment. Supported by IGA_LF_UP_2023_005 a MZ ČR – RVO (FNOL, 00098892). Keywords: Acute promyelocytic leukemia, Central venous catheter