Saif M W, Leitman S F, Cusack G, Horne M, Freifeld A, Venzon D, PremKumar A, Cowan K H, Gress R E, Zujewski J, Kasten-Sportes C
National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, MD, USA.
Ann Oncol. 2004 Sep;15(9):1366-72. doi: 10.1093/annonc/mdh347.
Apheresis catheters have simplified collection of peripheral blood stem cells (PBSC), but may be associated with thrombosis of the instrumented vessels. We performed a retrospective analysis to study the prevalence of thromboembolism associated with the use of femoral apheresis catheters in patients with breast cancer.
Patients were participants in clinical trials of high-dose chemotherapy with autologous PBSC rescue. They underwent mobilization with either high-dose cyclophosphamide (n = 21) or cyclophosphamide/paclitaxel (n = 64), followed by filgrastim. Double lumen catheters (12 or 13 Fr) were placed in the femoral vein and removed within 12 h of the last apheresis procedure. Apheresis was performed using a continuous flow cell separator and ACD-A anticoagulant. Thromboembolism was diagnosed by either venous ultrasonography or ventilation-perfusion scan.
Nine of 85 patients (10.6%) undergoing large volume apheresis with use of a femoral catheter developed thromboembolic complications. Pulmonary embolus (PE) was diagnosed in five and femoral vein thrombosis in four patients. Four of the five patients who developed PE were symptomatic; one asymptomatic patient had a pleural-based, wedge-shaped lesion detected on a staging computed tomography scan. The mean number of apheresis procedures was 2.4 (range one to four) and the mean interval between removal of the apheresis catheter and diagnosis of thrombosis was 17.6 days. In contrast, none of 18 patients undergoing apheresis using jugular venous access and none of 54 healthy allogeneic donors undergoing concurrent filgrastim-mobilized PBSC donation (mean 1.7 procedures/donor) using femoral access experienced thromboembolic complications.
Thromboembolism following femoral venous catheter placement for PBSC collection in patients with breast cancer may be more common than previously recognized. Healthy PBSC donors are not at the same risk. Onset of symptoms related to thrombosis tended to occur several weeks after catheter removal. This suggests that the physicians not only need to be vigilant during the period of apheresis, but also need to observe patients for thromboembolic complications after the catheter is removed. The long interval between the removal of apheresis catheter and the development of thromboembolism may have a potential impact on prophylactic strategies developed in future, such as the duration of prophylactic anticoagulation. Avoidance of the femoral site in breast cancer patients, and close prospective monitoring after catheter removal, are indicated.
单采导管简化了外周血干细胞（PBSC）的采集过程，但可能与置管血管的血栓形成有关。我们进行了一项回顾性分析，以研究乳腺癌患者使用股静脉单采导管相关的血栓栓塞发生率。
患者参与了采用自体PBSC解救的大剂量化疗临床试验。他们接受了大剂量环磷酰胺（n = 21）或环磷酰胺/紫杉醇（n = 64）动员，随后使用非格司亭。将双腔导管（12或13 Fr）置于股静脉，并在最后一次单采程序后12小时内拔除。使用连续流动血细胞分离机和ACD - A抗凝剂进行单采。通过静脉超声或通气灌注扫描诊断血栓栓塞。
85例使用股静脉导管进行大容量单采的患者中有9例（10.6%）发生了血栓栓塞并发症。5例诊断为肺栓塞（PE），4例为股静脉血栓形成。发生PE的5例患者中有4例有症状；1例无症状患者在分期计算机断层扫描中发现胸膜下楔形病变。单采程序的平均次数为2.4次（范围1至4次），拔除单采导管至诊断血栓形成的平均间隔时间为17.6天。相比之下，18例使用颈静脉通路进行单采的患者以及54例使用股静脉通路同时接受非格司亭动员的PBSC捐献（平均每位捐献者1.7次程序）的健康同种异体供者均未发生血栓栓塞并发症。
乳腺癌患者采用股静脉导管采集PBSC后发生血栓栓塞可能比之前认为的更为常见。健康的PBSC供者不存在同样的风险。与血栓形成相关的症状往往在导管拔除数周后出现。这表明医生不仅在单采期间需要保持警惕，而且在导管拔除后还需要观察患者是否有血栓栓塞并发症。拔除单采导管与血栓栓塞发生之间的长时间间隔可能会对未来制定的预防策略产生潜在影响，例如预防性抗凝的持续时间。建议乳腺癌患者避免使用股静脉部位，并在导管拔除后进行密切的前瞻性监测。
