[Use of Ommaya Reservoirs in the management of acute leukemias in children and adolescents: Guidelines from the French Society for Childhood and Adolescent Cancer and Leukemia (SFCE) Committee].

Abstract

The use of Ommaya reservoirs for intraventricular chemotherapy in pediatric acute leukemias remains heterogeneous, despite being a valuable alternative when lumbar puncture (LP) is unsuccessful or contraindicated. This study aimed to evaluate national practices and develop harmonized recommendations under the auspices of the French Society for the Fight Against Childhood and Adolescent Cancers and Leukemias (SFCE) Committee. A national 34-item questionnaire was distributed to 83 pediatric hemato-oncologists within the SFCE network, covering indications, surgical procedures, dosing, bedside practices, and complication management. Thirty-two responses from 24 centers were analyzed. The primary indication for Ommaya reservoir placement was the inability to perform LP. In cases of refractory or relapsed leukemic meningitis, pharmacokinetic data support its use due to improved methotrexate distribution in cerebrospinal fluid (CSF). A 50% dose reduction for intrathecal medications (methotrexate, cytarabine, hydrocortisone) is recommended, ensuring equivalent efficacy and improved tolerance. Strict aseptic techniques are essential to minimize infection risk (5-8%). In the event of infection, temporary removal of the device is advised. The Ommaya reservoir represents an effective and safe alternative to the lumbar route in selected cases. These recommendations aim to standardize practices and enhance patient safety.