Central venous device-related infection and thrombosis in patients treatedwith moderate dose continuous-infusion interleukin-2

BACKGROUND. This study was performed to determine the incidence of central venous device-related blood stream infection and thrombosis in patients tre ated with moderate dose continuous-infusion interleukin-2 (IL-2). METHODS. The records of 160 consecutive patients treated at the University of Wisconsin Hospital and Clinics, between June 1990 and June 1997, with mo derate dose continuous-infusion IL-2 (IL-2 [1.5-3.0 X 10(6) U/m(2)/day] Hof fman-LaRoche, Nutley, NJ or IL-2 [4.5 X 10(6) U/m(2)/day] Chiron Corporatio n, Berkely, CA) were reviewed retospectively. The majority of patients had metastatic melanome (78 patients) or renal cell carcinoma (70 patients). Al l of the patients had a surgically implanted central venous device placed b efore starting IL-2 therapy; 89% of these were cuffed Hickman catheters. Ei ghty-four patients received 1 mg of warfarin per day as prophylaxis against device-related thrombosis; none received periinsertion prophylaxis antibio tics. RESULTS. Twenty-one patients (13%) developed central venous device-related bloodstream infection (DRBSI) during the study period, a rate of 2 DRBSI pe r 1000 device-days. DRBSIs were associated with the type of immunotherapy g iven with IL-2 (P = 0.01) and with thrombosis (odds ratio, 4.1; 95% confide nce interval, 1.5-11.4; P = 0.008) but not with patient gender, type of can cer, duration of the central device, or site of device placement. Twenty-si x patients (16%) developed central venous device-related thrombosis (DRT) d uring immunotherapy. Low dose warfarin did not appear to prevent thrombosis . Device-related thrombosis was associated with DRBSI but not with patient gender, type of cancer, type of device, duration or location of device, or concomitant immunotherapy. CONCLUSIONS. Central venous DRBSI and DRT are significant complications tha t can occur during moderate dose continuous-infusion IL-2 therapy. The risk of DRBSI appears lower than the risk reported with high dose IL-2 therapy by previous investigators. The risk of DRT appears to be higher than the ri sk reported for patients with similar devices but not given IL-2. Low dose warfarin did not prevent DRT when started after device placement. (C) 2001 American Cancer Society.