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Pleural Management Pathways and Outcomes in Haematological Malignancy-Associated Malignant Pleural Effusion
Olivia Walsh1,2, Alguili Elshekih1,2, Dinesh Addala1,2
1Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK.
Journal of Clinical Medicine
|July 15, 2026
Summary
Many patients with hematological malignancy-associated malignant pleural effusion (MPE) can avoid early definitive intervention. An aspiration-first strategy is effective for selected patients with chemo-responsive disease, challenging current guidelines.
Area of Science:
- Pulmonology
- Hematology
- Oncology
Background:
- Malignant pleural effusion (MPE) is a common, burdensome complication of advanced cancers.
- Current guidelines for MPE intervention are based on solid tumors, with limited data for hematological malignancies.
Purpose of the Study:
- To evaluate the effectiveness of early definitive pleural intervention for hematological malignancy-associated MPE.
- To compare outcomes between aspiration-first strategies and early definitive interventions in this patient group.
Main Methods:
- Retrospective cohort study of adult patients with hematological malignancy-associated MPE.
- Analysis of time to definitive pleural intervention (indwelling pleural catheter, talc pleurodesis, or surgery) after initial management.
- Cox regression to identify factors associated with progression to definitive intervention.
Main Results:
- Of 116 patients with hematological MPE, 70% managed with an aspiration-first strategy avoided definitive intervention.
- 30% of patients required definitive pleural intervention, with non-chemo-responsive disease predicting earlier progression.
- An aspiration-first approach was successful in controlling effusions for a significant proportion of patients.
Conclusions:
- Hematological malignancy-associated MPE may not require early definitive intervention, unlike MPE from solid tumors.
- An aspiration-first strategy is a viable option for selected patients, particularly those with anticipated chemo-responsive disease.
- This challenges existing guidelines and suggests a more tailored approach to MPE management in hematological malignancies.
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