Hemorrhage During Induction Chemotherapy in Neuroblastoma: Additional Risk Factors in High-Risk Patients
Background: Neuroblastoma is the most common solid extracranial tumor in children. Patients affected by neuroblastoma are stratified into low, intermediate, and high risk in terms of event-free and overall survival. Some high-risk patients have an additional risk of acute hemorrhagic complications d...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-11-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2021.761896/full |
| _version_ | 1818856412833382400 |
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| author | Valerio Voglino Giorgio Persano Alessandro Crocoli Aurora Castellano Annalisa Serra Ugo Giordano Gian Luigi Natali Pier Luigi Di Paolo Cristina Martucci Alessandra Stracuzzi Alessandro Inserra |
| author_facet | Valerio Voglino Giorgio Persano Alessandro Crocoli Aurora Castellano Annalisa Serra Ugo Giordano Gian Luigi Natali Pier Luigi Di Paolo Cristina Martucci Alessandra Stracuzzi Alessandro Inserra |
| author_sort | Valerio Voglino |
| collection | DOAJ |
| description | Background: Neuroblastoma is the most common solid extracranial tumor in children. Patients affected by neuroblastoma are stratified into low, intermediate, and high risk in terms of event-free and overall survival. Some high-risk patients have an additional risk of acute hemorrhagic complications during induction chemotherapy.Aim: To find easily and rapidly assessed parameters that help clinicians identify those patients affected by high-risk neuroblastoma who have an additional risk of hemorrhagic complications.Methods: The clinical notes of patients diagnosed with high-risk neuroblastoma from January 2013 until February 2021 were retrospectively reviewed. Clinical, demographic and laboratory data, biological characteristics of the tumor, and information about treatment and hospital stay were identified.Results: In the examined period, 44 patients were diagnosed with high-risk neuroblastoma. Four of these patients had hemorrhagic complications within 2–7 days after the initiation of induction chemotherapy; two patients had hemothorax, one patient had hemoperitoneum and one patient had hemothorax and hemoperitoneum. The patient with isolated hemoperitoneum was treated with blood components transfusions, clotting factors and colloids infusions; the three patients with hemothorax underwent thoracostomy tube placement and respiratory support. At initial presentation, patients who suffered from hemorrhagic complications had a higher degree of hypertension (stage 2, p = 0.0003), higher levels of LDH (median 3,745 U/L, p = 0.009) and lower levels of hemoglobin (mean 7.6 gr/dl, p = 0.0007) compared to other high-risk patients.Conclusions: A subgroup of “additional” high-risk patients can be identified within the high-risk neuroblastoma patients based on mean arterial pressure, LDH levels and hemoglobin levels at presentation. Further studies to define cut-off values and optimal management strategies for these patients are needed. |
| first_indexed | 2024-12-19T08:24:06Z |
| format | Article |
| id | doaj.art-88b22044d91e47e88c3228e5caa30ffb |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-19T08:24:06Z |
| publishDate | 2021-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-88b22044d91e47e88c3228e5caa30ffb2022-12-21T20:29:20ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602021-11-01910.3389/fped.2021.761896761896Hemorrhage During Induction Chemotherapy in Neuroblastoma: Additional Risk Factors in High-Risk PatientsValerio Voglino0Giorgio Persano1Alessandro Crocoli2Aurora Castellano3Annalisa Serra4Ugo Giordano5Gian Luigi Natali6Pier Luigi Di Paolo7Cristina Martucci8Alessandra Stracuzzi9Alessandro Inserra10Surgical Oncology—General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, ItalySurgical Oncology—General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, ItalySurgical Oncology—General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, ItalyOnco-Hematology Unit, Department of Onco-Hematology and Gene Therapy, Bambino Gesù Children's Hospital IRCCS, Rome, ItalyOnco-Hematology Unit, Department of Onco-Hematology and Gene Therapy, Bambino Gesù Children's Hospital IRCCS, Rome, ItalySport and Hypertension Medicine Unit, Department of Cardiac Surgery, Cardiology, Heart and Lung Transplant, Bambino Gesù Children's Hospital IRCCS, Rome, ItalyRadiology Unit, Department of Diagnostic Imaging, Bambino Gesù Children's Hospital IRCCS, Rome, ItalyRadiology Unit, Department of Diagnostic Imaging, Bambino Gesù Children's Hospital IRCCS, Rome, ItalySurgical Oncology—General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, ItalyPathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital IRCCS, Rome, ItalySurgical Oncology—General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, ItalyBackground: Neuroblastoma is the most common solid extracranial tumor in children. Patients affected by neuroblastoma are stratified into low, intermediate, and high risk in terms of event-free and overall survival. Some high-risk patients have an additional risk of acute hemorrhagic complications during induction chemotherapy.Aim: To find easily and rapidly assessed parameters that help clinicians identify those patients affected by high-risk neuroblastoma who have an additional risk of hemorrhagic complications.Methods: The clinical notes of patients diagnosed with high-risk neuroblastoma from January 2013 until February 2021 were retrospectively reviewed. Clinical, demographic and laboratory data, biological characteristics of the tumor, and information about treatment and hospital stay were identified.Results: In the examined period, 44 patients were diagnosed with high-risk neuroblastoma. Four of these patients had hemorrhagic complications within 2–7 days after the initiation of induction chemotherapy; two patients had hemothorax, one patient had hemoperitoneum and one patient had hemothorax and hemoperitoneum. The patient with isolated hemoperitoneum was treated with blood components transfusions, clotting factors and colloids infusions; the three patients with hemothorax underwent thoracostomy tube placement and respiratory support. At initial presentation, patients who suffered from hemorrhagic complications had a higher degree of hypertension (stage 2, p = 0.0003), higher levels of LDH (median 3,745 U/L, p = 0.009) and lower levels of hemoglobin (mean 7.6 gr/dl, p = 0.0007) compared to other high-risk patients.Conclusions: A subgroup of “additional” high-risk patients can be identified within the high-risk neuroblastoma patients based on mean arterial pressure, LDH levels and hemoglobin levels at presentation. Further studies to define cut-off values and optimal management strategies for these patients are needed.https://www.frontiersin.org/articles/10.3389/fped.2021.761896/fullhigh-risk neuroblastomahemorrhagic complicationshemothoraxhemoperitoneumchemotherapy complications |
| spellingShingle | Valerio Voglino Giorgio Persano Alessandro Crocoli Aurora Castellano Annalisa Serra Ugo Giordano Gian Luigi Natali Pier Luigi Di Paolo Cristina Martucci Alessandra Stracuzzi Alessandro Inserra Hemorrhage During Induction Chemotherapy in Neuroblastoma: Additional Risk Factors in High-Risk Patients Frontiers in Pediatrics high-risk neuroblastoma hemorrhagic complications hemothorax hemoperitoneum chemotherapy complications |
| title | Hemorrhage During Induction Chemotherapy in Neuroblastoma: Additional Risk Factors in High-Risk Patients |
| title_full | Hemorrhage During Induction Chemotherapy in Neuroblastoma: Additional Risk Factors in High-Risk Patients |
| title_fullStr | Hemorrhage During Induction Chemotherapy in Neuroblastoma: Additional Risk Factors in High-Risk Patients |
| title_full_unstemmed | Hemorrhage During Induction Chemotherapy in Neuroblastoma: Additional Risk Factors in High-Risk Patients |
| title_short | Hemorrhage During Induction Chemotherapy in Neuroblastoma: Additional Risk Factors in High-Risk Patients |
| title_sort | hemorrhage during induction chemotherapy in neuroblastoma additional risk factors in high risk patients |
| topic | high-risk neuroblastoma hemorrhagic complications hemothorax hemoperitoneum chemotherapy complications |
| url | https://www.frontiersin.org/articles/10.3389/fped.2021.761896/full |
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