DP037 | PERIANAL DISEASE IN ACUTE LEUKEMIA PATIENTS: RISK FACTORS AND MANAGEMENT OF A RARE BUT FEARSOME COMPLICATION

Background: Perianal infections (fistulas, abscesses) in acute leukemia (AL) patients (pts) occur with an incidence of 7.3%. Because the poor clinical presentation in neutropenic pts, mortality rate is high. There is no universally accepted treatment strategy. Aim: Evaluate risk factors and management of AL pts with perianal disease. Materials and methods: A retrospective study was conducted on 98 AL pts at our clinic unit, undergoing high-dose chemotherapy (HDCT). Results: Median age was 56 (IQR 21–73); 54.1% were male. 78.6% had AML, 14.2% ALL-B, 6.1% ALL-T. Pre-existing anorectal disease (AD) was found in 12.2%. AD was mostly diagnosed during induction HDCT (68%), median onset 26 days (IQR 2–579). Twenty-nine pts developed perianal disease: 21 hemorrhoids (72.6%) —16 grade I-II (55.4%) and 5 grade III-IV (17.2%) —2 fistulas (6.8%), 3 abscesses (10.3%), and 3 fissures (10.3%). Conservative treatment was preferred (82.7%), mainly carbapenem-based (39.9%), while surgery was needed in 5 cases. Recovery occurred in 89%, with 6.8% recurrence. One pt developed fatal necrotizing fasciitis and died. Risk factors analyzed were age (≥60, 40-60, <40 years), sex, leukemia type, comorbidities (obesity, diabetes, pre-existing anorectal disease), cytogenetic risk, hospitalization duration, prophylaxis (antibiotic/antifungal), induction HDCT regimen type, neutropenia duration, G-CSF stimulation days and mucosal toxicity. Of these, only age and pre-existing AD were independently associated with perianal complications. Multivariable analysis revealed that younger pts (<40) had a higher risk of AD than older (p=0.0081). Median time to AD in the <40 age group was 8.2 months (95% CI: 0.9; Not Estimable). Pts with pre-existing AD had a more than threefold increased risk of developing perianal infections during HDCT (HR=3.517, 95% CI:1.492-8.290; p=0.0040), and 50% developed complications within the first 60 days. Conservative treatment was superior to surgery for healing (p=0.0027). Perianal complications were not significantly associated with febrile neutropenia (p=0.6738) or bacteremia (p=0.7725). Conclusions: Perianal infections are rare but potentially life-threatening in HDCT treated AL pts. This analysis highlights the importance of detailed medical history (e.g. pre-existing AD), close monitoring and timely interventions with broad-spectrum antibiotic therapies and selective surgical interventions to reduce the risk of fatal outcomes in this setting.