The risk of traumatic lumbar punctures in children with acute lymphoblastic leukaemia

• Published in: European journal of cancer (1990) Vol. 50; no. 8; pp. 1482 - 1489
• Main Authors: Shaikh, Furqan, Voicu, Laura, Tole, Soumitra, To, Teresa, Doria, Andrea S, Sung, Lillian, Alexander, Sarah
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.05.2014; Elsevier
• Subjects: Adolescent; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Cerebrospinal Fluid - cytology; Child; Cohort Studies; Disease-Free Survival; Female; Hematology, Oncology and Palliative Medicine; Humans; Infant; Leukaemia; Logistic Models; Lymphoid; Male; Medical sciences; Paediatrics; Pharmacology. Drug treatments; Precursor cell lymphoblastic leukaemia-lymphoma; Precursor Cell Lymphoblastic Leukemia-Lymphoma - cerebrospinal fluid; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Retrospective Studies; Risk Factors; Spinal puncture; Spinal Puncture - adverse effects; Survival Analysis; Tumors; Precursor cell lymphoblastic leukaemia-lymphoma; Spinal puncture; Lymphoid; Child; Paediatrics; Leukaemia; Human; Precursor cell; Lymphoblastic lymphoma; Risk; Malignant hemopathy; Lymphoid neoplasm; Non Hodgkin lymphoma; Trauma; Lumbar puncture; Cancerology; Lymphoproliferative syndrome; Risk factor; Acute lymphocytic leukemia; Cancer
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2014.02.021

Abstract Background Traumatic lumbar punctures with blasts (TLP+) in children with acute lymphoblastic leukaemia (ALL) obscure central nervous system status and are associated with a poorer event-free survival (EFS). Methods We conducted a retrospective cohort study of all lumbar punctures (LPs) for children with ALL diagnosed at our institution from 2005 to 2009. We utilised random-effects and fixed-effects repeated-measures logistic regression analyses to identify risk factors for TLPs. Fixed-effects models use each patient as his or her own control. We used survival analysis to describe outcomes after a TLP+. Results 264 children underwent 5267 evaluable lumbar punctures (LPs), of which 944 (17.9%) were traumatic. In the multivariable random-effects model, variables significantly associated with TLPs were age <1 year (odds ratio (OR) 3.46, 95% confidence interval (CI) 2.06–5.81) or age ⩾10 years (OR 2.00, CI 1.66–2.40); body mass index percentile ⩾95 (OR 1.44, CI 1.19–1.75); platelet count <100 × 103 /μL (OR 1.49, CI 1.08–20.7); fewer days since previous LP (OR 5.13, CI 2.34–11.25 for ⩾16 days versus 0–3 days); and a preceding TLP (OR 1.43, CI 1.19–1.73). In the fixed-effects model, image-guidance reduced the odds of TLP (OR 0.55, CI 0.32–0.95). The 5-year EFS (±SE) for children with TLP+ (77 ± 8%) was significantly lower than for children with CNS1 status (93 ± 2%; p = 0.002). Conclusions The frequency of TLP remains high. Consistent with previous studies, a TLP+ at diagnosis was associated with a poorer EFS. These risk factors can allow identifying interventions to reduce TLPs and directing interventions to those at highest risk.