Spinal epidural lipomatosis in children with hematologic malignancies

Abnormal fat deposition in the epidural space or spinal epidural lipomatosis (SEL) due to corticosteroid treatment or obesity may cause obstruction to cerebrospinal fluid flow. Little is known about SEL in patients with hematologic malignancies who require frequent lumbar punctures and corticosteroi...

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Bibliographic Details
Published in:Annals of hematology 2011-09, Vol.90 (9), p.1067-1074
Main Authors: Brennan, Rachel C., Helton, Kathleen J., Pei, Deqing, Cheng, Cheng, Inaba, Hiroto, Metzger, Monika L., Howard, Scott C., Rubnitz, Jeffrey E., Ribeiro, Raul C., Sandlund, John T., Jeha, Sima, Pui, Ching-Hon, Bhojwani, Deepa
Format: Article
Language:English
Subjects:
Adolescent
Adult
Child
Child, Preschool
Epidural Space
Female
Hematologic Neoplasms - complications
Hematologic Neoplasms - epidemiology
Hematology
Humans
Lipomatosis - epidemiology
Lipomatosis - etiology
Male
Medicine
Medicine & Public Health
Obesity - complications
Obesity - epidemiology
Oncology
Original Article
Overweight - complications
Overweight - epidemiology
Retrospective Studies
Risk Factors
Spinal Diseases - epidemiology
Spinal Diseases - etiology
Young Adult
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Summary:Abnormal fat deposition in the epidural space or spinal epidural lipomatosis (SEL) due to corticosteroid treatment or obesity may cause obstruction to cerebrospinal fluid flow. Little is known about SEL in patients with hematologic malignancies who require frequent lumbar punctures and corticosteroid treatment that places them at risk. Records and radiologic images of patients with SEL and leukemia or non-Hodgkin lymphoma (NHL) treated at a single institution from 1999–2009 were reviewed. Risk factors were compared with 405 control patients with leukemia. Fourteen patients with leukemia or NHL were diagnosed with SEL. The majority of patients underwent diagnostic imaging after unsuccessful lumbar punctures within 1 month of their primary diagnosis. Prior to SEL diagnosis, all patients received systemic and/or intrathecal corticosteroids. SEL diagnosis led to modification of intrathecal administration in eight patients, including Ommaya reservoir placement in four patients. All patients completed protocol-specified chemotherapy without neurologic symptoms or surgical intervention. Risk factors for developing SEL include older age and high body mass index. Investigation for SEL in leukemia or lymphoma patients with difficult lumbar punctures is warranted. Placement of an Ommaya reservoir may facilitate safe CNS-directed therapy in severely affected patients.
ISSN:0939-5555
1432-0584
DOI:10.1007/s00277-011-1183-6