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.
Keywords
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References
- Central nervous system disease in hematologic malignancies: historical perspective and practical applications.Semin Oncol. 2009; 36: S2-S16
- Traumatic lumbar puncture at diagnosis adversely affects outcome in childhood acute lymphoblastic leukemia.Pediatr Blood Cancer. 2000; 96: 3381-3384
- Diagnostic cerebrospinal fluid examination in children with acute lymphoblastic leukemia: significance of low leukocyte counts with blasts or traumatic lumbar puncture.J Clin Oncol. 2003; 21: 184-188
- Prognostic significance of blasts in the cerebrospinal fluid without pleocytosis or a traumatic lumbar puncture in children with acute lymphoblastic leukemia: experience of the Dutch Childhood Oncology Group.J Clin Oncol. 2006; 24: 2332-2336
- The influence of previous lumbar puncture and pneumoencephalography on the incidence of unsuccessful radioisotope cisternography.J Nucl Med. 1971; 12: 555-557
- Headache and backache after lumbar puncture in children and adolescents: a prospective study.Pediatrics. 2004; 113: 1588-1592
- Fluoroscopy-guided lumbar puncture: decreased frequency of traumatic tap and implications for the assessment of CT-negative acute subarachnoid hemorrhage.Am J Neuroradiol. 2001; 22: 571-576
- Estimating effective dose to pediatric patients undergoing interventional radiology procedures using anthropomorphic phantoms and MOSFET dosimeters.Am J Roentgenol. 2010; 194: 1315-1322
- Risk factors for traumatic and bloody lumbar puncture in children with acute lymphoblastic leukemia.JAMA. 2002; 288: 2001-2007
- Safety of lumbar puncture for children with acute lymphoblastic leukemia and thrombocytopenia.JAMA. 2000; 284: 2222-2224
- Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.Pediatrics. 2007; 120: S164-S192
- Incidence of traumatic lumbar puncture: experience of a large, tertiary care pediatric hospital.Clin Pediatr. 2011; 50: 1005-1009
A SAS Program for the CDC Growth Charts. [Web Page] Atlanta, GA: Centers for Disease Control and Prevention; 2011 [March 2012]. Available from: http://www.cdc.gov/nccdphp/dnpao/growthcharts/resources/sas.htm.
- Fixed effects regression methods for longitudinal data: using SAS.SAS Institute Inc, Cary, NC2005
- Applied longitudinal analysis.Wiley, New Jersey2011
- Fixed effects, random effects and GEE: what are the differences?.Stat Med. 2009; 28: 221-239
Guideline for platelet transfusion thresholds for pediatric hematology/oncology patients: Complete reference guide. Edmonton, AB: The C17 Guidelines Committee; 2010 [updated March 2011March 2011]. Available from: http://www.c17.ca/index.php?cID=86.
- Imaging in pediatric patients: time to think again about surveillance.Pediatr Blood Cancer. 2010; 55: 407-413
- Ultrasound imaging for lumbar punctures and epidural catheterisations: systematic review and meta-analysis.BMJ. 2013; 346: f1720
- Thrombotic complications in childhood acute lymphoblastic leukemia: a meta-analysis of 17 prospective studies comprising 1752 pediatric patients.Pediatr Blood Cancer. 2006; 108: 2216-2222
Article info
Publication history
Published online: March 21, 2014
Accepted:
February 11,
2014
Received in revised form:
January 21,
2014
Received:
August 12,
2013
Identification
Copyright
© 2014 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
