Anorectal Complications of Chemotherapy in Oncohematologic Patients

AIM. To study the probability of anorectal complications in various chemotherapy programs for oncohematologic patients. MATERIALS & METHODS. This retrospective study enrolled 654 patients (310 men and 344 women; the median age was 52 years) first admitted to the National Research Center for Hematology in the period from January 2019 to June 2020. In these patients, various oncohematologic diseases were diagnosed: non-Hodgkin lymphomas (NHL) in 41.9 %, multiple myeloma (MM) in 26.15 %, acute lymphoblastic leukemia (ALL) in 12.84 %, and acute myeloid leukemia (AML) in 19.11 % of cases. The median follow-up was 113 days. RESULTS. Rectal disorders were registered in 145/654 patients (22.17 %), more commonly anal fissures (7.34 %) and chronic hemorrhoids (5.81 %) were diagnosed. Pararectal soft-tissue infection (PSTI) was identified in 4.48 % of patients. The probability of anorectal complications by Day 180 from the beginning of chemotherapy varied depending on the type of malignancy and accounted for 31 % in AML, 29 % in ALL, 23 % in NHL, and 9 % in MM. A significant increase in the probability of anorectal diseases was associated with the administration of anthracyclines (33 % vs. 18 %; p = 0.0004), cytarabine-based regimens (32 % vs. 20 %; p = 0.0112), and methotrexate (58 % vs. 22 %; p = 0.0196). The probability of PSTI by Day 180 appeared to be considerably higher in acute leukemia (AML 11 %, ALL 10 %) vs. NHL (2 %) and MM (1 %) patients (p = 0,0007). CONCLUSION. In implementing the current treatment programs for oncohematologic diseases, the probability of anorectal complications is associated with a variety of causes but depends most strongly on the immunomorphological variant of the disease and cytotoxic agents used.