Catheter Complications in Patients Undergoing Extracorporeal Photopheresis for Management of Graft-Versus-Host Disease

Introduction Complications associated with central vascular access (VA) in patients (pts) undergoing extracorporeal photopheresis (ECP) may limit therapy. VA options often include dual lumen vortex (DLV) implantable and tunneled trifusion/other (TF) catheters. There is limited data about VA associated complications such as infection, thrombosis, and equipment failure in those undergoing ECP. Objectives Our primary aim was to describe VA associated complications during ECP. Methods We retrospectively reviewed pts who received ECP at our institution from January 2011 to October 2019. We examined episodes of cellulitis, catheter associated bacterial infection (CLABSI), catheter removal/exchange (CRE), and discontinuation of ECP. Results Fifty-two pts had at least 4 ECP sessions using VA. 12 were treated for acute and 40 for chronic/overlap GvHD (cGvHD). Overall, median # ECP sessions (ES) was 35 (range 4-311), median # ECP months (EM) was 7 (range 0.5 to 86). Total number of VA events = 21. In cGvHD (n=40), Median ES was 50 (range 14-311). With DLV catheters (16/40 pts), total VA events = 8 (1 event every 133 ES). 5 events required CRE, and 3 pts resumed ECP after event. With TF catheters (24/40 pts), total VA events = 8 (1 event every 142 ES). 2 events required CRE, and 4 pts restarted ECP after event. In acute GVHD (n=12), median ES was 15 (range 4-83). 11/12 used a TF catheter. CLABSI was diagnosed in 5/12 pts, all of whom were already hospitalized for GvHD therapy. 3/5 required CRE. ECP was discontinued in all events due to progressive GvHD or infection. Conclusion During ECP for cGvHD treatment, DLV and TF catheters have similar number of complications (p=0.81) when adjusted for total ES and EM. VA events are a major cause of ECP discontinuation. In aGvHD, the high incidence of CLABSI is attributed to severe immunosuppression from therapy rather than specific catheter related events.