12th Congress of the European Hematology ... - Haematologica

0609
SOFT TISSUE COMPLICATIONS IN PEDIATRIC LEUKEMIA PATIENTS WITH AND WITHOUT
CATHETERS
F. Demircioglu, S. Yilmaz, H. Oren, G. Irken, A.A. Ozguven
Dokuz Eylul University, IZMIR, Turkey
Background. Skin and soft tissue complications due to invasive procedures
for the administration of chemotherapeutic agents, blood sampling
and supportive therapy are frequently seen in patients with
leukemia. Central venous lines are an essential tool in the management
of these patients especially in developed countries. Despite their benefits,
catheters are often associated with local or bloodstream infections
and a higher rate of infection in developing countries are expected due
to low socioeconomic conditions, insufficient training and care. Frequency
of skin and soft tissue complications in pediatric leukemia patients
with and without catheters have not been compared previously. Aims.
We wanted to evaluate skin and soft tissue complications secondary to
procedures in acute leukemia patients with and without catheters and
if the frequency of these complications is less in patients with catheters.
Methods. Patient records of the children who were diagnosed and treated
as acute leukemia between January 1996 and January 2006 in our
hematology department were retrospectively evaluated. The following
data were collected for each patient: age, gender, insertion of catheter,
catheter type, catheter related complication, reason for removal, duration
of induction and consolidation treatment, and skin and soft tissue
complications in patients without catheters (e.g. sellulitis, abscess, drug
extravasation). Patients were treated with ALL BFM 95 or AML BFM 93-
98 protocols. Results. 87 acute leukemia patients (75 ALL, 12 AML) were
included. There were 30 patients with 37 catheter use (6 port, 31 Hickman
catheter) and 57 patients without catheter. Median age of all
patients was 6 years, in patients with catheters 3.6 years and in patients
without catheters 8 years. Median age of patients with catheters were
significantly lower than patients without catheter (p=0.004). There was
no gender difference between the patients with and without catheters
(F/M ratio was 15/15 and 28/29, respectively; p=0.938). 37 catheters
were removed for various reasons: 20 (54.1%) end of treatment, 5
(13.5%) infection, 3 (8.1%) unrelated death, 2 (5.4%) thrombosis, 2
(5.4%) tearing, one (2.7%) displacement, and 4 (10.8%) spontaneous
removal. In patients with catheters, skin and soft tissue complications
were seen in 20 (66%) children. Most frequent complication was cellulitis
(n=11, 55%), which was followed by drug extravasation (n=6, 30%),
skin ulceration, abscess and hematoma with one patient each. In one
patient, coagulase negative Staphylococcus was shown in blood culture.
In patients without catheter, skin and soft tissue complications were
seen in 37(65%) patients as the following: 14 (37.8%) cellulitis, 14
(37.8%) extravasation, 7 (18.9%) abscess, and 2 (5.5%) skin ulceration.
Blood cultures were positive in 6 patients (Klebsiella oxytoca, Staphylococcus
aureus, Pseudomonas aureginosa, coagulase negative Staphylococcus,
E. coli and E.coli + Pseudomonas aureginosa). When the frequency
of skin and soft tissue complications in patients with and without
catheters were compared to each other, there was statistically no significant
difference (p=0.792). The duration of chemotherapy was significantly
longer in patients who developed skin and soft tissue complications
with or without catheters when compared to duration of therapy
in patients without any skin and soft tissue complications (259.2±36.3
and 218.3±58.3 days, respectively; p