European Journal of Haematology最新文献

Background: Children diagnosed with leukemia require prolonged central venous access for chemotherapy, transfusions, and supportive care. Due to their immunocompromised status, coagulopathies, and intensive treatment protocols, they may be at increased risk for central venous access device (CVAD)-related complications, including infection, thrombosis, and mechanical failure. This study aimed to quantify the incidence and characterize the nature of CVAD-associated complications in this high-risk pediatric population.

Methods: A systematic review (1970-2025) was conducted using PRISMA guidelines, including studies describing CVAD-associated complications in children (≤ 18 years old) undergoing treatment for leukemia. The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool was used to assess the studies' quality. Meta-analysis and proportional meta-analysis for non-comparative studies (Freeman-Tukey transformation) using the random-effects model were conducted.

Results: Six databases were searched identifying 1126 articles: 1102 were excluded and 24 studies with 13 879 CVADs were included. CVAD-associated complications identified included: device failure 18.5% (95% CI 10.8-27.8), central line-associated bloodstream infection (CLABSI) 31.3% (95% CI 23.6-39.6), local infection 5.4% (95% CI 2.5-9.3), CVAD-associated venous thromboembolism (VTE) 5.2% (95% CI 2.9-8.3), dislodgement/migration 2.4% (95% CI 1.5-3.5), breakage/rupture 3% (95% CI 1.9-4.3), occlusion 5.3% (95% CI 1.5-11.2), wound dehiscence 4.4% (95% CI 2.2-7.3), and accidental removal 4.9% (95% CI 2.0-9.0). Tunneled central venous access devices (TCVADs) were associated with a higher proportion of complications when compared to totally implantable venous access devices (TIVADs).

Conclusion: Device failure and CLABSI are the CVAD-associated complications with the highest incidence rates. Comparing CVAD subtypes, TCVADs may have a higher complication risk than TIVADs. Further large prospective studies with long-term follow-up are needed to investigate these findings and determine their impact on patient morbidity and mortality.

Since 2004, patients receiving imatinib with relapse in non-marrow sites were given dasatinib to preserve control of leukemic marrow. Remissions in CNS and other organs began to be reported and are continuously observed to present. With resistance to one BCR::ABL1 tyrosine kinase inhibitor and sensitivity to a dual BCR::ABL1/SRC inhibitor recognized, we undertook a retrospective observational study of all reported patients with EML given dasatinib ± routine therapies used over 50 years. We elicited remission durations from authors. One hundred and sixty-three patients (150 Ph′+, 13 Ph′− negative leukemias) received dasatinib ± conventional EML treatments. All but six cases reported disappearance of EML involvement, documented by MRI, CSF, PET/CT in 10, and autopsy in 2. To date, 36 EML remissions have lasted 2+–11+ years (15 > 4 years). Thirty-four of the responding patients had post-dasatinib transplants and 3 CAR-T therapy. The tyrosine kinase inhibitor overexpressed in our prior RNAseq studies of EML tissue was LCK, a SRC kinase target of dasatinib known to be present in CNS, nerves, and some cancers. We present published data to support LCK as one possible tissue target in EML. As there has never been any durably effective treatment for EML, these observations merit prospective trials to validate the observed success of dasatinib and determine the role of additional therapies including cellular therapies. Dasatinib is a potentially practice-changing targeted therapy for EML. Finding and eradicating EML could increase the possibility of lengthy disease-free survival.

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.