dalteparin to prevent complications in cancer patients receiving chemotherapy through a catheter

Conditions: Cervical Cancer; Chronic Myeloproliferative Disorders; Leukemia; Lymphoma; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic Syndromes; Precancerous/Nonmalignant Condition; Unspecified Adult Solid Tumor, Protocol Specific; Veno-occlusive Disease

Summary: rationale: the use of dalteparin may be able to prevent complications caused by the use of a catheter to supply chemotherapy to cancer patients. it is not yet known if dalteparin is effective in reducing these complications. purpose: randomized phase iii trial to determine the effectiveness of dalteparin in preventing catheter-related complications in cancer patients who are receiving chemotherapy through a catheter.

objectives: i. determine if dalteparin will reduce the incidence of clinically significant catheter related complications (i.e., asymptomatic catheter related thrombosis) in cancer patients receiving chemotherapy through a central venous catheter. outline: this is a randomized, double-blind, placebo-controlled, multicenter study. patients are stratified according to treatment center and catheter placement (proximal to axilla vs distal to axilla). patients are randomized to one of two treatment arms. arm i: patients receive dalteparin subcutaneously (sc) daily. arm ii: patients receive placebo sc daily. treatment continues for 16 weeks or until catheter removal in the absence of unacceptable toxicity. patients are followed for 30 days. projected accrual: a total of 345 patients (230 in arm i and 115 in arm ii) will be accrued for this study over 6 months.

Eligibility criteria:
inclusion criteria: * histologically confirmed malignancy * no more than 5 days since placement of central venous catheter for administration of chemotherapy * expected length of catheter use at least 16 weeks * 18 and over * performance status: ecog 0-2 * life expectancy: at least 16 weeks * hematopoietic: * platelet count at least 100,000/mm3 * absolute neutrophil count at least 1,500/mm3 * no known coagulopathy * hepatic: bilirubin no greater than 2 times upper limit of normal (uln) except in case of gilbert's syndrome * ast no greater than 3 times uln (no greater than 5 times uln in case of liver metastases) * pt/ptt no greater than 1.5 times uln renal: * creatinine no greater than 2 times uln cardiovascular: * hiv negative * must weigh at least 90 pounds * at least 3 months since prior eye, ear, or cns surgery other: * at least 30 days since prior aspirin, dipyridamole, unfractionated heparin, other low molecular weight heparins, or other anticoagulation therapy (except heparin flushing) exclusion criteria: * uncontrolled hypertension, unstable angina, or symptomatic congestive heart failure * myocardial infarction in past 6 months * uncontrolled cardiac arrhythmia other: * known hypersensitivity (including heparin induced thrombocytopenia) to dalteparin, heparin, or other low molecular weight heparins * active uncontrolled infection, including existing catheter related infection * cns trauma in past 3 months * retinal detachment in past 6 months * mental incapacitation or psychiatric illness that would preclude study compliance * other serious concurrent disease that would preclude study participation * active gastrointestinal or genitourinary tract bleeding * intracranial or intraocular hemorrhage in past year * concurrent high dose chemotherapy with stem cell transplantation * concurrent induction/consolidation chemotherapy for leukemia * concurrent high dose chemotherapy with stem cell transplantation

Keywords: stage i adult hodgkin lymphoma stage ii adult hodgkin lymphoma stage iii adult hodgkin lymphoma stage iv adult hodgkin lymphoma monoclonal gammopathy of undetermined significance recurrent adult hodgkin lymphoma 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 recurrent cutaneous t-cell non-hodgkin lymphoma stage ib cervical cancer burkitt lymphoma isolated plasmacytoma of bone extramedullary plasmacytoma refractory multiple myeloma stage 0 chronic lymphocytic leukemia stage i multiple myeloma stage ii multiple myeloma stage iii multiple myeloma stage i chronic lymphocytic leukemia stage ii chronic lymphocytic leukemia stage iv chronic lymphocytic leukemia recurrent adult acute myeloid leukemia recurrent adult acute lymphoblastic leukemia relapsing chronic myelogenous leukemia refractory chronic lymphocytic leukemia unspecified adult solid tumor, protocol specific chronic phase chronic myelogenous leukemia accelerated phase chronic myelogenous leukemia blastic phase chronic myelogenous leukemia meningeal chronic myelogenous leukemia untreated adult acute lymphoblastic leukemia untreated adult acute myeloid leukemia adult acute myeloid leukemia in remission adult acute lymphoblastic leukemia in remission chronic idiopathic myelofibrosis essential thrombocythemia untreated hairy cell leukemia progressive hairy cell leukemia, initial treatment refractory hairy cell leukemia stage i grade 1 follicular lymphoma stage i grade 2 follicular lymphoma stage i grade 3 follicular lymphoma stage i adult diffuse small cleaved cell lymphoma stage i adult diffuse mixed cell lymphoma stage i adult diffuse large cell lymphoma stage i adult immunoblastic large cell lymphoma stage i adult lymphoblastic lymphoma stage i adult burkitt lymphoma chronic myelomonocytic leukemia t-cell large granular lymphocyte leukemia acute undifferentiated leukemia stage iii grade 1 follicular lymphoma stage iii grade 2 follicular lymphoma stage iii grade 3 follicular lymphoma stage iii adult diffuse small cleaved cell lymphoma stage iii adult diffuse mixed cell lymphoma stage iii adult diffuse large cell lymphoma stage iii adult immunoblastic large cell lymphoma stage iii adult lymphoblastic lymphoma stage iii adult burkitt lymphoma stage iv grade 1 follicular lymphoma stage iv grade 2 follicular lymphoma stage iv grade 3 follicular lymphoma stage iv adult diffuse small cleaved cell lymphoma stage iv adult diffuse mixed cell lymphoma stage iv adult diffuse large cell lymphoma stage iv adult immunoblastic large cell lymphoma stage iv adult lymphoblastic lymphoma stage iv adult burkitt lymphoma recurrent grade 1 follicular lymphoma recurrent grade 2 follicular lymphoma recurrent grade 3 follicular lymphoma recurrent adult diffuse small cleaved cell lymphoma recurrent adult diffuse mixed cell lymphoma recurrent adult diffuse large cell lymphoma recurrent adult immunoblastic large cell lymphoma recurrent adult lymphoblastic lymphoma recurrent adult burkitt lymphoma 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 secondary acute myeloid leukemia de novo myelodysplastic syndromes previously treated myelodysplastic syndromes secondary myelodysplastic syndromes primary central nervous system lymphoma prolymphocytic leukemia primary systemic amyloidosis veno-occlusive disease stage i mantle cell 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 adult diffuse small cleaved cell lymphoma contiguous stage ii mantle cell lymphoma contiguous stage ii adult diffuse mixed cell lymphoma contiguous stage ii adult immunoblastic large cell lymphoma contiguous stage ii adult diffuse large cell lymphoma contiguous stage ii adult burkitt lymphoma contiguous 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 adult diffuse small cleaved cell lymphoma noncontiguous stage ii mantle cell lymphoma noncontiguous stage ii adult diffuse mixed cell lymphoma noncontiguous stage ii adult immunoblastic large cell lymphoma noncontiguous stage ii adult diffuse large cell lymphoma noncontiguous stage ii adult burkitt lymphoma noncontiguous stage ii adult lymphoblastic lymphoma stage iii mantle cell lymphoma stage iv mantle cell lymphoma recurrent mantle cell lymphoma angioimmunoblastic t-cell lymphoma anaplastic large cell lymphoma noncontiguous stage ii small lymphocytic lymphoma noncontiguous stage ii marginal zone lymphoma recurrent marginal zone lymphoma recurrent small lymphocytic lymphoma stage i marginal zone lymphoma stage i small lymphocytic lymphoma stage iii small lymphocytic lymphoma stage iii marginal zone lymphoma stage iv small lymphocytic lymphoma stage iv marginal zone lymphoma contiguous stage ii marginal zone lymphoma contiguous stage ii small lymphocytic lymphoma extranodal marginal zone b-cell lymphoma of mucosa-associated lymphoid tissue nodal marginal zone b-cell lymphoma splenic marginal zone lymphoma