Vascular access for daunorubicin during childhood acute lymphoblastic leukaemia induction treatment: A UKCCSG supportive care group and MRC childhood leukaemia working party survey

Daunorubicin was reintroduced into induction chemotherapy in UK protocols for intermediate- and high-risk childhood acute lymphoblastic leukaemia in 1999. Concern about the risk of central venous catheter-associated venous thromboembolism led to a recommendation that induction treatment should be given by peripheral venous access wherever possible, whilst recognising anxieties concerning the risk of daunorubicin extravasation. A survey performed to determine how these conflicting concerns influenced practice in the administration of daunorubicin revealed considerable variation. The results highlight that recommendations were not being followed and that local practice and guidance were being utilised in this area of practice. However, there is a need to identify patients at higher risk of venous thromboembolism during induction treatment and better strategies to prevent this complication.