A Frontline Approach With Peripherally Inserted Versus Centrally Inserted Central Venous Catheters For Remission Induction Chemotherapy Phase Of Acute Myeloid Leukemia: A Randomized Comparison

Abstract Background Peripherally inserted central catheter (PICC)-related adverse events are uncertain in the setting of acute myeloid leukemia (AML), as compared with centrally inserted central catheter (CICC). Methods We conducted a monocentric, randomized trial involving patients with previously untreated AML, in which 46 received PICC and 47 received CICC as frontline intravascular device. Thereafter, all patients underwent intensive chemotherapy for hematological remission induction. The primary end point was catheter-related (CR)-bloodstream infection (BSI) and vein thrombosis (VT) rate. The secondary endpoints were catheter malfunctions, removals and patient overall survival. Results CR-BSI and VT rates in the PICC and CICC groups were 13% and 49% respectively, with a difference of 36 percentage points (RR for a CR-BSI or VT, 0.266; P = 0.0003). CR-BSI incidences were 1.4 and 7.8 per 1000 catheters per-day in the PICC and CICC groups, respectively. Among CR-thromboses, symptomatic (s) VT rates were 2.1% in the PICC group and 10.6% in the CICC group. In the CICC group, 16/47 patients (34%) had the catheter removed for BSI (n= 5), septic thrombophlebitis (n= 4), VT (n= 2) or malfunction (n= 5) after seven median days from insertion. In the PICC group, only 6/46 patients (13%) required catheter removal for VT (n= 2) or malfunction (n= 4). At 30-days median follow-up, six deaths for CR-complications occurred in the CICC-assisted patients versus none CR-deaths in the PICC-assisted patients ( P = 0.012). With the PICC-driven strategy, BSI and sVT reduction decreases CR-infection and venous thromboembolism mortality, whereas CICC approach leads to early removals of catheters mostly for difficult-to-treat infectious pathogens. Conclusions Our data confirms that BSI and sVT are the major complications affecting frontline central intravascular device related-morbidity in leukemia setting. PICC is safer than CICC while maintaining effectiveness for AML patients undergoing chemotherapy, with about 4-fold lower combined risk of infection or thrombosis at 30 days.