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To the Editor, Immune cell suppression by inhalation anesthetics can decrease patients’ response to chemotherapy for leukemia, although only a few reports have examined this [1]. We investigated the relationship between general anesthesia methods (propofol and sevoflurane) for tunneled central venous catheter (tCVC) insertion in pediatric patients with precursor B cell acute lymphocytic leukemia (BCP-ALL) and the residual leukemic blast cell count in peripheral blood on day 8 following prednisolone chemotherapy (day8 PB blast cell count), an indicator of response to treatment [2]. The subjects of this single-center retrospective cohort study were BCP-ALL patients aged less than 18 years who underwent tCVC insertion under general anesthesia. During the research period of January 2012 through October 2018, the same chemotherapy protocol was used as the primary treatment for pediatric BCP-ALL at our institution. The exclusion criteria decided beforehand were discontinuation of prednisolone chemotherapy, age less than 1 year and/or positive Philadelphia chromosome cases requiring different treatment methods [2], and tCVC insertion after starting chemotherapy. The relationship between anesthesia method and the residual day-8 PB blast cell count was examined using logistic regression analysis and inverse probability of treatment weighting (IPTW) by propensity scoring. A cohort of 57 patients with pediatric BCP-ALL was evaluated. The residual day-8 PB blast count was significantly lower in cases anesthetized with sevoflurane than propofol (crude odds ratio [OR] = 0.27; 95% confidence interval [CI], 0.085–0.86; P = 0.045), but no difference was observed when the values were adjusted for age (adjusted OR = 2.32; 95% CI, 0.70–7.65; P = 0.167) (Table 1). Furthermore, after adjustment by the IPTW method, there was no significant difference between the two groups (adjusted OR = 0.61; 95% CI, 0.16–2.3; P = 0.47) (Table 2). In this study, the number of patients with residual leukemic blast cells was significantly lower in patients receiving sevoflurane than in those receiving propofol. The reason for this result contrary to the hypothesis may be that the children in the propofol group were significantly older. Therefore, the gen-

ja clinical reports

Association between the choice of anesthesia method and reactivity to chemotherapy in children with acute lymphocytic leukemia: a preliminary retrospective cohort study