PURPOSE: Pleural effusions in hematologic malignancies may be a clinical quagmire. The safety and efficacy of pleural catheters in these patients is unknown.
METHODS: 146 consecutive pleural catheters in patients with hematologic malignancies placed from January 1997 to December 2009 were reviewed. Clinical history and laboratory data were extracted and analyzed. Preliminary data for 28 patients who underwent 34 pleural catheter insertions are presented.
RESULTS: 28 patients (M=15, F=13) were identified. The median age was 61 years (interquartile range 56-74). Tumor pathologies included ALL (4), AML (10), CLL (7), CML (2), and multiple myeloma (9). Most patients underwent 2 (±1.5) pleural procedures on either hemithorax prior to catheter placement. Effusions were categorized as follows: exudates (23), transudates (8), indeterminate(1). Malignant pleural effusions were the etiology in 23 patients, 2 were secondary to chemoradiation therapy and underlying cardiac disease was responsible in 3 patients. 11 catheter insertions were performed with platelets < 50,000/cubic centimeter. Effective pleural symphsyis led to removal of 7 catheters whereas 3 were removed due to complications. Median duration of catheter was 35 days (interquartile range 14-61 days). 10 of 34(29%%) catheters developed complications. 3 were peri-operative complications (bleeding in 1 and iatrogenic pneumothorax in 2). 1 patient developed entry site infection and 1 patient developed an empyema requiring decortication. 3 catheters were occluded without obliteration of pleural space and 2 patients had refractory pain beyond 3 weeks of catheter placement. 2 patients are alive with effective pleurodesis.
CONCLUSIONS: Indwelling tunneled pleural catheter placement is not associated with excessive bleeding in patients with hematologic malignancies.
CLINICAL IMPLICATIONS: Prospective studies are needed to understand the role of indwelling tunneled pleural catheter for palliation in patients with hematologic malignancies.
DISCLOSURE: The following authors have nothing to disclose: Archan Shah, Lara Bashoura, Amit Vaid, Paresh Patel, Carlos Jimenez, Rodolfo Morice, George Eapen, Saadia Faiz
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