Early hospital discharge with oral antimicrobial therapy in patients with hematologic malignancies and low-risk febrile neutropenia

Although consensus exists relating criteria for the identification of low-risk patients with febrile neutropenia, no clear indication on how to manage these patients has been so far provided particularly in outpatients affected by hematologic malignancies. The feasibility and safety of early discharge was prospectively evaluated in 100 outpatients with hematologic malignancies and febrile neutropenia. A strategy considering the risk-index of the Multinational Association of Supportive Care in Cancer (MASCC) was applied. High-risk patients were entirely managed at hospital. Low-risk patients were early discharged if they were afebrile since 48 h and not on supportive therapy requiring hospitalization. Out of 90 low-risk episodes, in 69 instances (76.7%), patients were discharged after a median of 4 days and continued home therapy with oral cefixime (78%) or other antibiotics. Only five outpatients (7.2%) had fever recurrence. Twenty-one low-risk patients were not early discharged due to worsening conditions (three deaths), need of multiple daily dose therapy, or discharge refuse. No clinical characteristic was able to predict the eligibility for early discharge. The MASCC risk-index is a useful aid in the identification of high-risk febrile neutropenia needing whole in-hospital treatment. As for low-risk patients, hospitalization at least in the first days of fever is required. Cefixime could be included among the oral antibacterial drugs to be used in the outpatient treatment of adult patients with febrile neutropenia

EARLY AND LATE COMPLICATIONS RELATED TO CENTRAL VENOUS CATHETERS IN HAEMATOLOGICAL MALIGNANCIES: A RETROSPECTIVE ANALYSIS OF 1102 PATIENTS

Several severe complications may be associated with the use of central venous catheters (CVC). We retrospectively evaluated on a large cohort of patients the incidence of CVC-related early and late complications. From 7/99 to 12/2005, 1102 CVC have been implanted at our Institution in 881 patients with haematological malignancies (142,202 total day number of implanted CVC). Early mechanic complications were 79 (7.2% - 0.55/1,000 days/CVC). Thirty-nine episodes of early infective complications (<1 week from CVC implant) occurred (3.5% - 0.3/1000 days/CVC): furthermore, 187 episodes of CVC-related sepsis (17% - 1.3/1000 days/CVC) were recorded. There were 29 episodes (2.6%) of symptomatic CVC-related thrombotic complications, with a median interval from CVC implant of 60 days (range 7 – 395). The rate of CVC withdrawal due to CVC-related complications was 26%. The incidence of CVC-related complications in our series is in the range reported in the literature, notwithstanding cytopenia often coexisting in haematological patients

Elderly patients with Ph+ chronic myelogenous leukemia (CML): Results of imatinib mesylate treatment

Thirty-five patients with Ph+ CML aged more than 60 years were treated with imatinib. Twenty-four patients (group A) were in late chronic phase (CP) and eleven patients (group B) were in accelerated/blastic phase (AP/BP). In group A, complete haematological response (CHR) was achieved by all patients; seventeen patients (70.8%) attained a complete cytogenetic response (CCR), one (4.1%) attained a partial CR, one (4.1%) a minor CR (Ph+ 70%) and five (21%) were resistant (Ph+ 100%), toxicity was mild: seven patients had a transient cytopenia, three a skin reaction, one a moderate oedema and one muscular pain. After a median follow-up of 15 months, 1 patient died in progression and 23 patients are alive (2 in BP and 21 in persisting response). In group B, one patient died after 3 months in aplastic phase from sepsis, three patients were resistant and seven patients (63.7%) achieved CHR; of these, four obtained CCR. After a median follow-up of 17 months, 4 patients have died from progressive disease, 6 are alive; 1 in AP and 5 in CHR (4 of them being in CCR). Present data indicate that imatinib is safe also in elderly with clinical results as good as in younger patients. © 2004 Elsevier Ltd. All rights reserved

Prospective unicentric analysis on the systematic use of peripherically inserted central catheters (picc lines) in allogenic hematopoietic stem cell transplantation

Background: In patients undergoing chemotherapy peripherally inserted central catheters (PICCs) seem to be associated with a lower rate of complications compared to conventional percutaneously inserted devices (CVADs). Moreover, the insertion and removal of PICCs are easier and the costs lower compared to CVADs. So far, there is limited experience on the use of PICCs in the setting of allogeneic hematopoietic stem cell transplantation (HSCT). In view of the advantages of PICCs vs CVADs, we decided to use PICCs in patients candidates to receive a HSCT. Here, we report the experience on the systematic use of PICCs in HSCT patients at the 'Sapienza' University of Rome. Methods: A total of 100 silicone or polyurethane PICCs have been inserted between October 2012 and August 2017. Catheter-related bloodstream infections (CRBSI), mechanical (malfunction, obstruction, dislocation, rupture) and catheter-related thrombotic complications (CRTCs) have been prospectively analyzed. Results: One hundred PICCs were insert into 100 patients (male/female 62%/38%; median age 47.5 years, range 18.7-64.8). Fifty-one patients received a HSCT from an unrelated donor, 33 from a sibling donor and 16 were haploidentical transplants. Fifty-six patients had an acute leukemia and 44 a chronic lymphoproliferative disease. Myeloablative (MAC) and reduced (RIC) intensity condition regimens were employed in 62 and 38 patients, respectively. Polyurethane and silicone PICCs were used in 52 and 48 patients, respectively. The devices were single lumen in 52 patients and double lumen in 48. Eighty-five and 15 PICCS were placed in the basilica and brachial vein, respectively. All devices were inserted without complications. CRBSIs occurred in 32% of cases, with a rate of 2.5 CRBIs per 1000 PICC days. A coagulase-negative Staphylococcus was the most common agent, not associated with clinically significant complications. The PICC was removed in all cases. In univariate analysis, PICC material was the only factor affecting CRBSIs: polyurethane 42% vs 20% silicone; p = 0.02. CRTCs were observed in 17% cases, with a rate of 1.3 CRTS per 1000 PICC days. Patients received anti- coagulant therapy with low-weight heparin followed by resolution. In univariate analysis, no variable showed a correlation with CRTC. Mechanical complications occurred in 15% of cases, corresponding to 1.2 mechanical complications per 1000 PICC days. The type of conditioning (MAC 33% vs RIC 56%; p = 0.014) and place of insertion (basilic 12% vs brachial vein 33%; p = 0.03) influenced mechanical complications. Both variables remained significant in multivariate analysis. Globally, the median duration of in situ PICC placement was 117 days (range16-561). Conclusions: In our experience, no complications have been observed with the use of PICCs in patients undergoing a HSCTs. Adverse events related to PICCs were manageable and did not affect transplant outcome. Silicone PICCs and a basilic vein access seem to correlate with a lower incidence of infectious and mechanical complications. We conclude that PICCs are a safe and reliable long-term venous access for patients undergoing an allogenic HSCT. Conflict of interest: All authors declare no conflict of interes