heparin or m-edta in preventing catheter-related infections and blockages in patients at high risk for a catheter-related infection

Conditions: Cancer

Summary: rationale: heparin or m-edta may prevent catheter-related infections and blockages in patients at high risk for a catheter-related infection. it is not yet known whether heparin is more effective than m-edta in preventing catheter-related infections and blockages in patients at high risk for a catheter-related infection. purpose: this randomized clinical trial is studying heparin to see how well it works compared with m-edta in preventing catheter-related infections and blockages in patients at high risk for a catheter-related infection.

objectives: primary * compare the incidence of catheter-related infections (staphylococcal and candida) in patients at high risk for a catheter-related infection treated with heparin vs minocycline hydrochloride and edetate calcium disodium (m-edta). secondary * compare the incidence of catheter occlusions in patients treated with these regimens. outline: this is a randomized, double-blind, prospective, multicenter study. patients are stratified according to type of catheter (tunneled central venous catheter \[cvc\] vs nontunneled percutaneous cvc) and participating center. patients are randomized to 1 of 2 treatment arms. * arm i: patients receive minocycline hydrochloride and edetate calcium disodium (m-edta) flush solution into the cvc once daily. * arm ii: patients receive heparin flush solution into the cvc once daily. treatment in both arms continues for up to 3 months in the absence of unacceptable toxicity or until the removal of the catheter. projected accrual: a total of 150 patients will be accrued for this study.

Eligibility criteria:
disease characteristics: * at high risk of acquiring a catheter infection, as evidenced by any of the following: * diagnosis of leukemia, lymphoma, myeloma, or melanoma-sarcoma * undergoing hematopoietic stem cell transplantation * receiving aldesleukin * pediatric cancer patients * new (≤ 10 days old) functioning externalized tunneled or nontunneled central venous catheter (cvc), such as a hickman/broviac or hohn catheter, or peripherally inserted central venous catheter (picc) utilized for infusion of chemotherapy, blood and blood products, or other intermittent infusions * no occluded cvc * no existing local or systemic catheter infection * more than 3 days since removal of a prior cvc due to an infection * no externalized cvc that is projected to remain in place for \< 2 weeks * no infusion ports or groshong catheters * no coated cvc impregnated with an antimicrobial or antiseptic agent patient characteristics: * life expectancy ≥ 3 months * no history of allergy to any tetracycline * no contraindication to flush solution dwell time of ≥ 4 hours * no hypocalcemia while receiving calcium supplementation through the catheter * not pregnant or nursing * fertile patients must use effective contraception prior concurrent therapy: * see disease characteristics

Keywords: infection poor vascular access thromboembolism adult acute myeloid leukemia with 11q23 (mll) abnormalities adult acute myeloid leukemia with inv(16)(p13;q22) adult acute myeloid leukemia with t(15;17)(q22;q12) adult acute myeloid leukemia with t(16;16)(p13;q22) adult acute myeloid leukemia with t(8;21)(q22;q22) accelerated phase chronic myelogenous leukemia adult acute lymphoblastic leukemia in remission adult acute myeloid leukemia in remission atypical chronic myeloid leukemia, bcr-abl negative blastic phase chronic myelogenous leukemia childhood acute lymphoblastic leukemia in remission childhood acute myeloid leukemia in remission childhood chronic myelogenous leukemia chronic eosinophilic leukemia primary myelofibrosis chronic myelomonocytic leukemia chronic neutrophilic leukemia chronic phase chronic myelogenous leukemia de novo myelodysplastic syndromes disseminated neuroblastoma extranodal marginal zone b-cell lymphoma of mucosa-associated lymphoid tissue juvenile myelomonocytic leukemia myelodysplastic/myeloproliferative neoplasm, unclassifiable nodal marginal zone b-cell lymphoma noncontiguous stage ii adult burkitt lymphoma noncontiguous stage ii adult diffuse large cell lymphoma noncontiguous stage ii adult diffuse mixed cell lymphoma noncontiguous stage ii adult diffuse small cleaved cell lymphoma noncontiguous stage ii adult immunoblastic large cell lymphoma noncontiguous stage ii adult lymphoblastic lymphoma noncontiguous stage ii grade 1 follicular lymphoma noncontiguous stage ii grade 2 follicular lymphoma noncontiguous stage ii grade 3 follicular lymphoma noncontiguous stage ii mantle cell lymphoma noncontiguous stage ii marginal zone lymphoma noncontiguous stage ii small lymphocytic lymphoma poor prognosis metastatic gestational trophoblastic tumor previously treated myelodysplastic syndromes recurrent adult acute lymphoblastic leukemia recurrent adult acute myeloid leukemia recurrent adult burkitt lymphoma recurrent adult hodgkin lymphoma recurrent adult diffuse large cell lymphoma recurrent adult diffuse mixed cell lymphoma recurrent adult diffuse small cleaved cell lymphoma recurrent adult immunoblastic large cell lymphoma recurrent adult lymphoblastic lymphoma recurrent breast cancer recurrent/refractory childhood hodgkin lymphoma recurrent childhood acute lymphoblastic leukemia recurrent childhood acute myeloid leukemia recurrent childhood large cell lymphoma recurrent childhood lymphoblastic lymphoma recurrent childhood small noncleaved cell lymphoma recurrent cutaneous t-cell non-hodgkin lymphoma recurrent grade 1 follicular lymphoma recurrent grade 2 follicular lymphoma recurrent grade 3 follicular lymphoma recurrent mantle cell lymphoma recurrent marginal zone lymphoma recurrent mycosis fungoides/sezary syndrome recurrent neuroblastoma recurrent ovarian epithelial cancer recurrent ovarian germ cell tumor recurrent small lymphocytic lymphoma recurrent malignant testicular germ cell tumor recurrent wilms tumor and other childhood kidney tumors refractory chronic lymphocytic leukemia refractory hairy cell leukemia refractory multiple myeloma relapsing chronic myelogenous leukemia secondary acute myeloid leukemia secondary myelodysplastic syndromes splenic marginal zone lymphoma stage i multiple myeloma stage ii multiple myeloma stage ii ovarian epithelial cancer stage iii adult burkitt lymphoma stage iii adult hodgkin lymphoma stage iii adult diffuse large cell lymphoma stage iii adult diffuse mixed cell lymphoma stage iii adult diffuse small cleaved cell lymphoma stage iii adult immunoblastic large cell lymphoma stage iii adult lymphoblastic lymphoma stage iii chronic lymphocytic leukemia stage iii grade 1 follicular lymphoma stage iii grade 2 follicular lymphoma stage iii grade 3 follicular lymphoma stage iii mantle cell lymphoma stage iii marginal zone lymphoma stage iii multiple myeloma stage iii ovarian epithelial cancer stage iii small lymphocytic lymphoma stage iii malignant testicular germ cell tumor stage iiia breast cancer stage iiib breast cancer stage iiic breast cancer stage iv adult burkitt lymphoma stage iv adult hodgkin lymphoma stage iv adult diffuse large cell lymphoma stage iv adult diffuse mixed cell lymphoma stage iv adult diffuse small cleaved cell lymphoma stage iv adult immunoblastic large cell lymphoma stage iv adult lymphoblastic lymphoma stage iv breast cancer stage iv chronic lymphocytic leukemia stage iv grade 1 follicular lymphoma stage iv grade 2 follicular lymphoma stage iv grade 3 follicular lymphoma stage iv mantle cell lymphoma stage iv marginal zone lymphoma stage iv ovarian epithelial cancer stage iv small lymphocytic lymphoma acute undifferentiated leukemia mast cell leukemia stage i adult t-cell leukemia/lymphoma stage ii adult t-cell leukemia/lymphoma stage iii adult t-cell leukemia/lymphoma stage iv adult t-cell leukemia/lymphoma recurrent adult t-cell leukemia/lymphoma t-cell large granular lymphocyte leukemia stage i chronic lymphocytic leukemia stage ii chronic lymphocytic leukemia meningeal chronic myelogenous leukemia prolymphocytic leukemia stage i adult hodgkin lymphoma stage ii adult hodgkin lymphoma stage i childhood hodgkin lymphoma stage ii childhood hodgkin lymphoma stage iii childhood hodgkin lymphoma stage iv childhood hodgkin lymphoma anaplastic large cell lymphoma angioimmunoblastic t-cell lymphoma stage i mycosis fungoides/sezary syndrome stage ii mycosis fungoides/sezary syndrome stage iii mycosis fungoides/sezary syndrome stage iv mycosis fungoides/sezary syndrome stage i cutaneous t-cell non-hodgkin lymphoma stage ii cutaneous t-cell non-hodgkin lymphoma stage iii cutaneous t-cell non-hodgkin lymphoma stage iv cutaneous t-cell non-hodgkin lymphoma adult grade iii lymphomatoid granulomatosis recurrent adult grade iii lymphomatoid granulomatosis childhood grade iii lymphomatoid granulomatosis recurrent childhood grade iii lymphomatoid granulomatosis waldenstrom macroglobulinemia stage i adult burkitt lymphoma stage i adult diffuse large cell lymphoma stage i adult diffuse mixed cell lymphoma stage i adult diffuse small cleaved cell lymphoma stage i adult immunoblastic large cell lymphoma stage i adult lymphoblastic lymphoma stage i grade 1 follicular lymphoma stage i grade 2 follicular lymphoma stage i grade 3 follicular lymphoma stage i mantle cell lymphoma stage i marginal zone lymphoma stage i small lymphocytic lymphoma contiguous stage ii adult burkitt lymphoma contiguous stage ii adult diffuse large cell lymphoma contiguous stage ii adult diffuse mixed cell lymphoma contiguous stage ii adult diffuse small cleaved cell lymphoma contiguous stage ii adult immunoblastic large cell lymphoma contiguous stage ii adult lymphoblastic lymphoma contiguous stage ii grade 1 follicular lymphoma contiguous stage ii grade 2 follicular lymphoma contiguous stage ii grade 3 follicular lymphoma contiguous stage ii mantle cell lymphoma contiguous stage ii marginal zone lymphoma contiguous stage ii small lymphocytic lymphoma stage i childhood large cell lymphoma stage ii childhood large cell lymphoma stage iii childhood large cell lymphoma stage iv childhood large cell lymphoma stage i childhood lymphoblastic lymphoma stage ii childhood lymphoblastic lymphoma stage iii childhood lymphoblastic lymphoma stage iv childhood lymphoblastic lymphoma stage i childhood small noncleaved cell lymphoma stage ii childhood small noncleaved cell lymphoma stage iii childhood small noncleaved cell lymphoma stage iv childhood small noncleaved cell lymphoma primary central nervous system non-hodgkin lymphoma post-transplant lymphoproliferative disorder intraocular lymphoma stage i melanoma stage ii melanoma stage iii melanoma stage iv melanoma recurrent melanoma unspecified adult solid tumor, protocol specific unspecified childhood solid tumor, protocol specific stage i adult soft tissue sarcoma stage ii adult soft tissue sarcoma stage iii adult soft tissue sarcoma stage iv adult soft tissue sarcoma recurrent adult soft tissue sarcoma metastatic childhood soft tissue sarcoma nonmetastatic childhood soft tissue sarcoma recurrent childhood soft tissue sarcoma localized ewing sarcoma/peripheral primitive neuroectodermal tumor metastatic ewing sarcoma/peripheral primitive neuroectodermal tumor recurrent ewing sarcoma/peripheral primitive neuroectodermal tumor previously treated childhood rhabdomyosarcoma previously untreated childhood rhabdomyosarcoma recurrent childhood rhabdomyosarcoma recurrent uterine sarcoma stage i uterine sarcoma stage ii uterine sarcoma stage iii uterine sarcoma stage iv uterine sarcoma localized osteosarcoma metastatic osteosarcoma recurrent osteosarcoma chondrosarcoma small intestine leiomyosarcoma recurrent small intestine cancer childhood myelodysplastic syndromes