Use of indwelling pleural catheters for patients with hematological malignancies and malignant pleural effusions

RATIONALE Malignant Pleural Effusions (MPE) are a known complication of hematological malignancies and can lead to dyspnea, impaired quality of life and hospitalization. Patients with hematological malignancies are often immunocompromised due to immunosuppressive chemotherapy or disease process itself. There is often hesitancy with the use of indwelling pleural catheters in this population due to the concern of infection. OBJECTIVE Our study examines this risk of infection and other complications associated with the use of indwelling pleural catheters (IPCs) in a Canadian cohort of patients with hematological malignancy. METHODS In this retrospective cohort study, we analyzed data from a pleural disease clinic at a tertiary-care center in Ottawa, Canada between 2006 and 2015. All patients who had an IPC inserted for the management of a symptomatic MPE due to a hematological malignancy (lymphoma, leukemia, multiple myeloma) were included. RESULTS Eighty-one patients were included in the cohort. Five patients (6%) had an infectious complication related to their IPC with no attributable deaths from an IPC. Most patients (81%) had symptomatic relief following IPC insertion. The median time to IPC removal was 51 days (IQR 28 - 116 days) in the 58% of patients who had their IPC removed. Patients with lymphoma had the highest likelihood of catheter removal. CONCLUSIONS The use of IPCs in patients with hematological malignancies is generally safe with an acceptable risk of infection given the clinical benefit. Definitive management of rapidly re-accumulating and symptomatic MPEs with an IPC can be considered for palliation of dyspnea in patients with hematological malignancy.