Prevalence and management of constipation in pediatric acute lymphoblastic leukemia in U.S. children's hospitals.

Abstract

Children with acute lymphoblastic leukemia (ALL) suffer from a litany of chemotherapy-induced side effects. Constipation secondary to vinca alkaloids, environmental changes, and opioid use is a common issue for children newly diagnosed with leukemia. We analyzed data from 48 children's hospitals in the Pediatric Health Information System, extracting patients 1-21 years of age with ALL hospitalized from October 2015 through September 2019. Our objective was to investigate the prevalence, risk factors, and treatment of constipation in hospitalized children with ALL. We identified 4647 unique patients with an ALL induction admission. Constipation was the most common gastrointestinal diagnosis with 1576 (33.9%; 95% confidence interval [CI]: 32.6%-35.3%) patients diagnosed during induction admission and 19.8% in post-induction admissions. The most commonly administered constipation medications were poly-ethyl glycol (n=3385, 89.6%), followed by senna (n=1240, 32.8%), lactulose (n=916, 24.2%), and docusate (n=914, 24.2%). Multivariate logistic regression revealed the following variables to be significantly associated with the presence of a constipation diagnosis: age<6 years at induction (compared with those ≥12 years; odds ratios [OR]=1.32 [95% CI: 1.13-1.55]; P=<0.001), female sex (OR=1.16 [95% CI: 1.02-1.31]; P=0.024), increased length of hospitalization (OR=1.03 [95% CI: 1.02-1.04]; P<0.0001), use of non-fentanyl opioids for one or two days (OR=1.28 [95% CI: 0.99-1.65]; P=0.056), and use of non-fentanyl opioids>2 days (OR=1.53 [95% CI: 1.19-1.95]; P<0.001). A large portion of hospitalized children with ALL experience constipation and required medications. Increased attention should be paid to constipation prophylaxis and treatment in ALL patients, particularly at the start of induction therapy.