European Journal of Haematology最新文献

Background: Central venous catheters (CVCs) are essential in pediatric hematology-oncology, for the administration of chemotherapy and supportive therapy. Thrombocytopenia increases the risk of bleeding and current guidelines recommend prophylactic platelet transfusions below 40-50 × 10⁹/L, though evidence is limited and transfusions entail risks and costs. Advances in procedural bundles and simulation-based training may enhance safety, enabling lower thresholds.

Methods: This retrospective observational cohort study analyzed 274 pediatric patients undergoing CVC insertion (PICC, CICC, and FICC) at a tertiary center (2020-2023). Patients were stratified by platelet count using 50 × 10⁹/L and 30 × 10⁹/L thresholds. Postoperative complications, including bleeding and thrombosis, were compared between groups. All procedures employed pediatric-specific bundles, and operators received simulation-based ultrasound-guided PICC training to optimize safety.

Results: Complication rates did not differ significantly with platelets above or below 50 × 10⁹/L (32.8% vs. 26.3%, p = 0.29) or 30 × 10⁹/L (32.6% vs. 27.1%, p = 0.29). Findings indicate lowering the transfusion threshold to 30 × 10⁹/L is safe. Bundles and simulation-based training likely contributed to low complication rates.

Conclusions: A 30 × 10⁹/L platelet transfusion threshold appears safe for pediatric CVC insertion. Emphasizing procedural bundles and simulation-based operator training may reduce transfusion needs, associated risks, and costs. Prospective multicenter studies are warranted to confirm safety and explore lower thresholds.

Background: Totally implantable venous access devices (TIVADs) are essential in pediatric oncology but can cause mechanical complications at removal. Identifying risk factors helps guide management and timing of elective removal. Our objective is to describe the incidence and determinants of mechanical complications that occur during the removal of TIVADs in a Chilean tertiary pediatric oncology center.

Methods: We performed a retrospective cross-sectional review of all TIVAD removal episodes at Hospital Guillermo Grant Benavente (Concepción, Chile) between June 2022 and May 2025. Demographic, oncologic, and device variables were collected; univariate comparisons examined associations with mechanical outcomes.

Results: Sixty-eight removals were analyzed. Mechanical complications occurred in 29.4% of procedures: difficult removal in 20 cases (29.4%), catheter retention in 12 (17.6%), and catheter fracture in 3 (4.4%). Mean indwelling time was greater in fractured devices (6.1 ± 0.6 years) compared with non-fractured devices (4.4 ± 1.7 years; p = 0.026), and longer in difficult removals (5.1 ± 1.2 vs. 4.2 ± 1.3 years; p = 0.011). Open technique was borderline associated with difficult removal (p = 0.050).

Conclusions: Prolonged indwelling time and open technique are the principal factors associated with mechanical problems during TIVAD removal. These findings support early recognition of high-risk devices and consideration of timely replacement or elective removal to reduce avoidable complications.

Infections remain a leading cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL), reflecting both intrinsic immune dysfunction and therapy-related immunosuppression. The pathogenesis of immunodeficiency in CLL is multifactorial: neoplastic B cells impair humoral immunity, T cells are functionally exhausted, and innate immune cells, particularly neutrophils and NK cells, display profound defects. Beyond impaired pathogen defense, these immune alterations actively support leukemic cell survival and promote a tolerogenic microenvironment. The advent of targeted therapies has reshaped the infectious risk profile. Bruton's tyrosine kinase inhibitors (BTKis) and venetoclax have largely replaced chemotherapy, reducing classic opportunistic infections but introducing new challenges. BTKis are associated with invasive fungal infections and increased pneumonia risk in combination regimens, while venetoclax frequently induces profound neutropenia. Anti-CD20 monoclonal antibodies cause long-lasting B-cell depletion and viral reactivation. These evolving risks demand nuanced approaches to prevention. Prophylactic strategies must be individualized. Antiviral prophylaxis is warranted with anti-CD20 antibodies and BTKis, and Pneumocystis jirovecii pneumonia (PJP) prophylaxis remains essential with fludarabine, cyclophosphamide, and rituximab (FCR) or prolonged corticosteroid therapy. Antifungal prophylaxis is not routinely indicated in CLL but may be considered in high-risk patients on BTKis or with refractory disease. Immunoglobulin replacement therapy (IgRT) reduces recurrent bacterial infections in patients with hypogammaglobulinemia, while vaccination—though often limited by suboptimal responses—remains the cornerstone of prevention. Timing before therapy or during treatment-free intervals is critical, and newer formulations, such as conjugate pneumococcal and recombinant zoster vaccines, are preferred. Future directions include developing predictive biomarkers of infection risk and vaccine responsiveness, integrating immune monitoring into clinical trials, and exploring strategies to modulate neutrophil plasticity and restore T-cell function. Until then, a pragmatic, risk-adapted approach combining vigilance, prophylaxis, immunoglobulin replacement, and optimized vaccination offers the best safeguard for patients with CLL.