{"doi":"10.1002/ajh.27720","title":"Clinical Factors Associated With Catheter‐Related <scp>VTE</scp> in Patients Undergoing Hematopoietic Cell Transplantation: A Multi‐Center Study","abstract":"Venous thromboembolism (VTE) is a clinically significant complication that occurs in patients undergoing allogeneic hematopoietic cell transplantation (HCT). Due to the prolonged need for indwelling central venous catheters (CVCs), the incidence of catheter-related deep venous thrombosis (CR-DVT) appears higher at 3%–4% than that of pulmonary embolism (PE) or lower extremity deep vein thrombosis (LE-DVT) at 1%–4% in the first year post-transplant [1-3]. Previous studies have limited power to assess risk factors associated with CR-DVT due to single-center design with uniform institutional practice. In the present study, we analyzed the incidence and risk factors associated with isolated CR-DVT from two large allogenic HCT centers. We performed a retrospective cohort study for patients undergoing first allogeneic HCT at MD Anderson Cancer Center (MDACC) 2016–2020 and Fred Hutchinson Cancer Center (FHCC) 2006–2019. Baseline patient characteristics included demographics, body mass index (BMI), pre-transplant disease, donor match, conditioning regimen, Karnofsky Performance Status (KPS), prior autologous HCT, common laboratory values, and CVC type. We defined CVC as a catheter that extended into the superior vena cava, with further sub-classification into peripherally inserted central catheter (PICC), non-tunneled CVC (placed by a vascular access team), and tunneled CVC (placed by Interventional Radiology). Time-varying variables included the status and duration of post-transplant hospitalizations and development of acute graft-versus-host disease (GVHD). The primary outcome of isolated CR-DVT was defined as isolated, symptomatic or incidentally found, acute upper extremity DVT associated with an ipsilateral CVC that was documented by either venogram, contrasted CT scan, or compression ultrasound. CR-DVT events concurrent with PE or LE-DVT were classified as the latter. Diagnostic imaging was performed based on clinical symptoms. There was no formal thrombosis risk stratification, thromboprophylaxis, surveillance, or screening program. The electronic medical records (EMR) of eligible patients were examined using ICD 9 or 10 codes to identify possible VTE events, while radiology reports were probed with a natural language processing (NLP) algorithm for the same purpose. All patients with possible new VTE events, including those with recurrent events, were individually confirmed on chart review. All patients were assessed from the time of transplant cell infusion until first thrombosis, death, loss to follow-up, or 366 days post-transplant. Isolated CR-DVT incidence was assessed by a cumulative incidence competing risk model, with death as a competing cause. Unadjusted and multivariable Cox proportional hazards models were used to measure the association between patient- and transplant-specific factors and time to CRT using a shared frailty model to account for clustering of patients from each site. Acute GVHD and inpatient hospitalization status were treated as time-varying covariates. To differentiate VTE diagnosed prior to admission versus hospital-acquired, we characterized the time-varying exposure as inpatient after 48 h of admission. A total of 4250 patients (2879 FHCC and 1371 MDACC) were included in the analysis. Baseline characteristics are shown in Table S1, and site-specific characteristics are shown in Table S2. The median age of the overall cohort was 54.8 years, 41.8% were female, and 80.7% were White. The indication for HCT was 66.7% myeloid leukemia, 16.0% lymphoid leukemia, 10.2% lymphoma, 4.1% myeloma, and 3.1% other. In the combined cohort, 73.6% had matched donors, 64.1% received myeloablative conditioning, and 11.4% had prior autologous HCT. Most patients (78%) had KPS ≥ 80. The median pre-conditioning white blood cell count (WBC), hemoglobin, and platelet count of the overall cohort were 3.5 × 109/L, 10.6 g/dL, and 114 × 109/L, respectively, while the median pre-conditioning creatinine, total bilirubin, and LDH","journal":"American Journal of Hematology","year":2025,"id":544238,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9638,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":378913,"name":"Danielle Guffey","orcid":"0000-0003-3721-614X","position":1,"is_corresponding":false},{"id":293098,"name":"Jonathan Avery","orcid":"0000-0003-2423-4197","position":2,"is_corresponding":false},{"id":55175,"name":"David García","orcid":"0000-0002-7820-050X","position":3,"is_corresponding":false},{"id":295731,"name":"Ryan Basom","orcid":"0000-0001-6137-1807","position":4,"is_corresponding":false},{"id":83997,"name":"Stephanie J. Lee","orcid":"0000-0003-2600-6390","position":5,"is_corresponding":false},{"id":1120396,"name":"Katherine M. Klein","orcid":null,"position":6,"is_corresponding":false},{"id":104772,"name":"Partow Kebriaei","orcid":"0000-0002-8607-9404","position":7,"is_corresponding":false},{"id":437553,"name":"Gabriela Rondón","orcid":"0000-0003-3841-3567","position":8,"is_corresponding":false},{"id":18375,"name":"Elizabeth J. Shpall","orcid":"0000-0003-3947-4126","position":9,"is_corresponding":false},{"id":1434471,"name":"Shida Jin","orcid":"0000-0001-7252-9702","position":10,"is_corresponding":false},{"id":941563,"name":"Elliana Young","orcid":null,"position":11,"is_corresponding":false},{"id":942897,"name":"Cristhiam M. Rojas‐Hernandez","orcid":"0000-0003-3890-3929","position":12,"is_corresponding":false},{"id":285765,"name":"Ang Li","orcid":"0000-0002-8455-2309","position":13,"is_corresponding":false},{"id":1434470,"name":"Naveen Subramanian","orcid":"0000-0001-9481-7975","position":0,"is_corresponding":true}],"reference_count":6,"raw_metadata":null,"created_at":"2026-07-19T02:53:12.864581Z","pmid":"40377378","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}