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Impact of Obesity on Lumbar Puncture Outcomes in Adults with Acute Lymphoblastic Leukemia and Lymphoma: Experience at an Academic Reference Center

Authors :
José Carlos Jaime-Pérez
Guillermo Sotomayor-Duque
Patrizia Aguilar-Calderón
Lorena Salazar-Cavazos
David Gómez-Almaguer
Source :
International Journal of Hematology-Oncology and Stem Cell Research, Vol 13, Iss 3 (2019)
Publication Year :
2019
Publisher :
Tehran University of Medical Sciences, 2019.

Abstract

Background: Lumbar puncture (LP) is a hematology procedure that can require repeated attempts leading to traumatic LP (TLP), which has been related to the central nervous system (CNS) relapse. LP success can depend on the size and anatomy of the patient and the skill of the hematologist. The main objective was to determine the influence of body mass index (BMI) on LP outcomes. Materials and Methods: Adults with lymphoid malignancies requiring LP were included prospectively over one year; hematology residents performed most procedures. A 22-gauge Quincke needle was employed. Comparison between non-traumatic vs. traumatic LPs according to BMI, CNS relapse, and residents’ year was performed. Results: Fifty-four patients with a mean age of 31.5±15.57 years were included. Diagnosis was Acute Lymphoblastic Leukemia-B (74%), Acute Lymphoblastic Leukemia-T (13%) and Non-Hodgkin Lymphoma (13%). 227 LPs were performed, 121 (53.3%) successful, 98 (43.2%) traumatic, 11 (11.2%) TLPs were macroscopically detectable and 87 (88%) microscopic; 8 (3.5%) were dry-taps. Median time between punctures was 11 days (1-202). Median BMI was 25 (22.8-39.6). Main indication for LP was prophylactic (74.5%); 39.2% were performed by first-year, 35.2% by second-year, 19.6% by third-year hematology residents. No difference (p = 0.145) for a TLP was found among residents. A BMI ≥30 (p = 0.040), non-palpable intervertebral space (p = 0.001) and more than one attempt (p = 0.001) were significant for TLP. TLP was not associated with CNS relapse (p = 0.962). Conclusion: Obesity predicted a TLP. A traumatic puncture did not increase the risk of CNS relapse at one-year follow-up.

Details

Language :
English
ISSN :
20082207
Volume :
13
Issue :
3
Database :
Directory of Open Access Journals
Journal :
International Journal of Hematology-Oncology and Stem Cell Research
Publication Type :
Academic Journal
Accession number :
edsdoj.70ab2338de7548809a2b4274afd28237
Document Type :
article
Full Text :
https://doi.org/10.18502/ijhoscr.v13i3.1274