ISSN 1866-8836
Клеточная терапия и трансплантация

N-04. Features of care for the patients with tumors of central nervous system at the stage of HSCT

Lyubov A. Shepeleva, Ilya V. Kazantsev, Polina S. Tolkunova, Tatiana V. Grishchenko, Olga I. Bogdanova, Margarita S. Khalipskaya, Denis V. Kozlov

RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia


Contact: Lyubov A. Shepeleva, phone: +7 (981) 930-28-23, e-mail: lyubovshep08@gmail.com

doi 10.18620/ctt-1866-8836-2023-12-3-1-176

Summary

One of the features of medical care for children is that most manipulations, even minimally invasive ones, such as taking liquor for analysis or intrathecal administration of drugs, are performed under general anesthesia. This is due to the unpleasant sensations that the intervention causes, anxiety when visiting the operating room and, as a result, low compliance of a small patient. An important feature of our department is working with patients who have an Ommaya reservoir implanted. When using the tank, we do not use anesthesia for lumbar punctures, as well as for endolumbal administration of chemotherapy drugs. Since 2021, a special multidisciplinary pediatric group was arranged at our Institute which includes pediatric oncologists, neurosurgeon, neurologist, and nurses in order to provide optimal care to patients who received high doses of chemotherapy during hematopoietic stem cell transplantation (HSCT).

Materials and methods

In addition to high-dose intravenous therapy, intraventricular chemotherapy using the Ommaya reservoir also plays an important role in patients with embryonic brain tumors. We have developed a training program that allows a nurse to master and perform the procedure in a short time, under the supervision of the attending physician. All these patients received single or tandem HSCT with autologous stem cells after surgical resection and chemotherapy, and about half of them (n=63) also underwent parallel intraventricular therapy through the Ommaya reservoir, consisting of intraventricular injections of methotrexate to young children (n=59), or etoposide in patients with recurrent embryonic brain tumor (n=71). From 2012 to 2022, a total of 140 patients with a median age of 6.5 (1-37) years were treated at the Department. The wast majority of patients were children and young adults with CNS tumors who required intraventricular therapy, of which most patients were diagnosed with medulloblastoma, primitive neuroectodermal tumors and other embryonic brain tumors.

Results

The clinical nurses performed 218 injections through the Ommaya reservoir for the period from 2021-2023 as the members of a multidisciplinary group, under the supervision of a pediatric oncologist. All manipulations were carried out safely, no immediate complications were observed. The following delayed adverse events were documented: headache, 20% of cases; subfebrile fever, 13%; dizziness, 5% of the patients; drowsiness, 7%; nausea and vomiting, 2% of cases. Infectious complications were detected in 0.01% of patients.

Conclusions

Usage of the Ommaya reservoir significantly reduces the amount of general anesthesia in these patients. The use of the reservoir allows you to take liquor for research, administer chemotherapy drugs, also at a day hospital unit. This practice may be extrapolated to other oncological departments. The safety of this procedure was shown under the conditions of a specialized department.

Keywords

Hematopoietic stem cell transplantation, CNS tumors, Ommaya reservoir, intrathecal therapy, chemotherapy drugs.


Supplement 12-3
09/30/2023

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doi 10.18620/ctt-1866-8836-2023-12-3-1-176

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