Cargando…
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...
Autores principales: | , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8635199/ https://www.ncbi.nlm.nih.gov/pubmed/34869118 http://dx.doi.org/10.3389/fped.2021.761896 |
_version_ | 1784608254863605760 |
---|---|
author | Voglino, Valerio Persano, Giorgio Crocoli, Alessandro Castellano, Aurora Serra, Annalisa Giordano, Ugo Natali, Gian Luigi Di Paolo, Pier Luigi Martucci, Cristina Stracuzzi, Alessandra Inserra, Alessandro |
author_facet | Voglino, Valerio Persano, Giorgio Crocoli, Alessandro Castellano, Aurora Serra, Annalisa Giordano, Ugo Natali, Gian Luigi Di Paolo, Pier Luigi Martucci, Cristina Stracuzzi, Alessandra Inserra, Alessandro |
author_sort | Voglino, Valerio |
collection | PubMed |
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. |
format | Online Article Text |
id | pubmed-8635199 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-86351992021-12-02 Hemorrhage During Induction Chemotherapy in Neuroblastoma: Additional Risk Factors in High-Risk Patients Voglino, Valerio Persano, Giorgio Crocoli, Alessandro Castellano, Aurora Serra, Annalisa Giordano, Ugo Natali, Gian Luigi Di Paolo, Pier Luigi Martucci, Cristina Stracuzzi, Alessandra Inserra, Alessandro Front Pediatr Pediatrics 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. Frontiers Media S.A. 2021-11-16 /pmc/articles/PMC8635199/ /pubmed/34869118 http://dx.doi.org/10.3389/fped.2021.761896 Text en Copyright © 2021 Voglino, Persano, Crocoli, Castellano, Serra, Giordano, Natali, Di Paolo, Martucci, Stracuzzi and Inserra. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pediatrics Voglino, Valerio Persano, Giorgio Crocoli, Alessandro Castellano, Aurora Serra, Annalisa Giordano, Ugo Natali, Gian Luigi Di Paolo, Pier Luigi Martucci, Cristina Stracuzzi, Alessandra Inserra, Alessandro Hemorrhage During Induction Chemotherapy in Neuroblastoma: Additional Risk Factors in High-Risk Patients |
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 | Pediatrics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8635199/ https://www.ncbi.nlm.nih.gov/pubmed/34869118 http://dx.doi.org/10.3389/fped.2021.761896 |
work_keys_str_mv | AT voglinovalerio hemorrhageduringinductionchemotherapyinneuroblastomaadditionalriskfactorsinhighriskpatients AT persanogiorgio hemorrhageduringinductionchemotherapyinneuroblastomaadditionalriskfactorsinhighriskpatients AT crocolialessandro hemorrhageduringinductionchemotherapyinneuroblastomaadditionalriskfactorsinhighriskpatients AT castellanoaurora hemorrhageduringinductionchemotherapyinneuroblastomaadditionalriskfactorsinhighriskpatients AT serraannalisa hemorrhageduringinductionchemotherapyinneuroblastomaadditionalriskfactorsinhighriskpatients AT giordanougo hemorrhageduringinductionchemotherapyinneuroblastomaadditionalriskfactorsinhighriskpatients AT nataligianluigi hemorrhageduringinductionchemotherapyinneuroblastomaadditionalriskfactorsinhighriskpatients AT dipaolopierluigi hemorrhageduringinductionchemotherapyinneuroblastomaadditionalriskfactorsinhighriskpatients AT martuccicristina hemorrhageduringinductionchemotherapyinneuroblastomaadditionalriskfactorsinhighriskpatients AT stracuzzialessandra hemorrhageduringinductionchemotherapyinneuroblastomaadditionalriskfactorsinhighriskpatients AT inserraalessandro hemorrhageduringinductionchemotherapyinneuroblastomaadditionalriskfactorsinhighriskpatients |