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Background/purpose: In neutropenic children with hematologic malignancies, the optimal timing of implanted central venous catheter (ICVC) insertion is unclear. The policy in our Institution has been to place ICVC at the time of diagnosis of disease regardless of the absolute neutrophil count. The impact of this strategy on the incidence of ICVC removal within 30 days of placement was evaluated in a series of patients. Other possible risk factors for ICVC early removal were also examined., Materials and Methods: Records of all children with hematologic malignancies who underwent placement of ICVC during 2007 to 2010 were reviewed. The incidence of catheter-related complications and early removal was compared between subjects who were neutropenic at the time of ICVC placement and those who had a normal absolute neutrophil count., Results: An ICVC was placed in 117 children, and only in 12 (10.2%) children it was removed within 30 days. However, the incidence of complications and removal was not influenced by the presence of neutropenia. Only an age below 2 years was demonstrated to be a risk factor for early complication and removal., Conclusions: The policy to place ICVC in neutropenic patients has been reasonably safe, in our hands. Meticulous preoperative evaluation, the accurate surgical technique and considerable care in their postoperative management are essential to prevent complications, especially in newborns and infants, who seem to be at greater risk of ICVC removal.

Objective: To determine whether a simplified, 1-day/week regimen of trimethoprim/sulfamethoxazole is sufficient to prevent Pneumocystis (jirovecii [carinii]) pneumonia (PCP). Current recommended regimens for prophylaxis against PCP range from daily administration to 3 consecutive days per week dosing., Study Design: A prospective survey of the regimens adopted for the PCP prophylaxis in all patients treated for childhood cancer at pediatric hematology-oncology centers of the Associazione Italiana Ematologia Oncologia Pediatrica., Results: The 20 centers participating in the study reported a total of 2466 patients, including 1093 with solid tumor and 1373 with leukemia/lymphoma (or primary immunodeficiency; n = 2). Of these patients, 1371 (55.6%) received the 3-day/week prophylaxis regimen, 406 (16.5%) received the 2-day/week regimen, and 689 (27.9%), including 439 with leukemia/lymphoma, received the 1-day/week regimen. Overall, only 2 cases of PCP (0.08%) were reported, both in the 2-day/week group. By intention to treat, the cumulative incidence of PCP at 3 years was 0.09% overall (95% CI, 0.00-0.40%) and 0.51% for the 2-day/week group (95% CI, 0.10%-2.00%). Remarkably, both patients who failed had withdrawn from prophylaxis., Conclusion: A single-day course of prophylaxis with trimethoprim/sulfamethoxazole may be sufficient to prevent PCP in children with cancer undergoing intensive chemotherapy regimens. This simplified strategy might have implications for the emerging need for PCP prophylaxis in other patients subjected to the increased use of biological and nonbiological agents that induce higher levels of immune suppression, such as those with rheumatic diseases., (Copyright © 2014 The Authors. Published by Mosby, Inc. All rights reserved.)