Extracorporeal photopheresis (ECP) is an established treatment for acute and chronic graft-versus-host disease (GVHD). It first involves removing and separating the patient’s blood, then treating it chemically, exposing it to ultraviolet light, and finally replacing the blood. However, ECP requires vascular access (VA), which is commonly achieved with either tunneled triple-lumen (TL) or dual-lumen implantable (DLV) catheters. There is a host of associated complications such as infection, thrombosis, and equipment failure.
A team from the Sylvester Comprehensive Cancer Center at the University of Miami, Miami, Florida, retrospectively assessed the outcomes of ECP in patients at their institution from January 2011-September 2022. Their outcomes of interest were incidence of infection, catheter exchange, and ECP discontinuation.
During the evaluation period, 73 patients (24 acute GVHD, 44 chronic GVHD, 5 overlap) were treated with at least 4 rounds of ECP with central VA. Of those, 58% were treated with a TL catheter, and 37% a DLV catheter (other catheter types accounted for 5%).
Twenty-two patients experienced VA events at a median of 172 days. For patients with TL catheters, 11 had central line-associated bloodstream infection (CLABSI), of whom, 5 had line removal and 6 line exchange. For those who had DLV catheters, 8 experienced CLABSI, 4 of whom required line removal. Those with DLV catheters were more likely to restart ECP after requiring line removal.
Notably, most patients with acute GVHD used a TL catheter, and most with chronic GVHD had a DLV catheter. The use of a TL catheter was associated with more VA events, but this may have been because those with acute GVHD were more likely to receive immunosuppressants.
The authors concluded that “VA events are major cause of ECP discontinuation and must balance quality of life and convenience with risk of infectious complications from ECP VA. They are often a cause of discontinuation, and only 39% of patients restarted ECP after VA.”
Diaz-Paez M, Mones K, Suzuki V, et al. Catheter Complications in Patients Undergoing Extracorporeal Photopheresis for Management of Graft-Versus-Host Disease. Abstract #367. Presented at the 2023 Tandem Meetings of ASTCT and CIBMTR; February 15-19, 2023; Orlando, FL.