Efficacy of Intralesional Aqueous Bleomycin in Treatment of Pediatric Lymphatic Malformations.

Abstract

Lymphatic malformations (LMs) are an aberrant developmental anomaly of dysplastic sequestrated lymphatic vessels. Though surgical excision has been the conventional treatment modality, it has been associated with injury to adjacent structures, recurrences, and poor cosmesis. Intralesional bleomycin has shown a promising role in the treatment of LMs, and we present our experience with aqueous intralesional bleomycin in the pediatric population including infants in terms of its efficacy, complications, and parental satisfaction. Children with clinically and ultrasound-proven macrocystic non-visceral LMs received aqueous bleomycin intralesionally under ultrasound guidance at 0.5 IU/kg/dose at monthly intervals and not exceeding five doses. Response to therapy and complications were monitored and regression graded as excellent (total disappearance), good (>50% reduction), and poor (<50% reduction). Our study included 26 children with a median age of 24 months (range 2-168) and a median weight of 12 kg (range 4-38). The most common site was the neck (37%). Duration of follow-up was 6 years (range 1-7). Response was excellent in 23/26 (88.4%) patients, good in 3/26 (11.5%), and poor in none (0%). Nine (34.6%) patients showed complete response with a single injection. None (0%) developed recurrence. Three (11.5%) children had minor complications such as fever and mild hypopigmentation. None developed any major complications. Parental satisfaction was excellent in 24/26 (92.3%) and good in 2/26 (7.7%) patients. Intralesional aqueous bleomycin sclerotherapy is a safe non-surgical intervention for macrocystic pediatric LMs with reasonably good outcomes and even better parental satisfaction.