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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	high-risk neuroblastoma hemorrhagic complications hemothorax hemoperitoneum chemotherapy complications Pediatrics RJ1-570
Acceso en línea:	https://doaj.org/article/88b22044d91e47e88c3228e5caa30ffb
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spelling	oai:doaj.org-article:88b22044d91e47e88c3228e5caa30ffb2021-11-16T06:57:01ZHemorrhage During Induction Chemotherapy in Neuroblastoma: Additional Risk Factors in High-Risk Patients2296-236010.3389/fped.2021.761896https://doaj.org/article/88b22044d91e47e88c3228e5caa30ffb2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fped.2021.761896/fullhttps://doaj.org/toc/2296-2360Background: 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.Valerio VoglinoGiorgio PersanoAlessandro CrocoliAurora CastellanoAnnalisa SerraUgo GiordanoGian Luigi NataliPier Luigi Di PaoloCristina MartucciAlessandra StracuzziAlessandro InserraFrontiers Media S.A.articlehigh-risk neuroblastomahemorrhagic complicationshemothoraxhemoperitoneumchemotherapy complicationsPediatricsRJ1-570ENFrontiers in Pediatrics, Vol 9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	high-risk neuroblastoma hemorrhagic complications hemothorax hemoperitoneum chemotherapy complications Pediatrics RJ1-570
spellingShingle	high-risk neuroblastoma hemorrhagic complications hemothorax hemoperitoneum chemotherapy complications Pediatrics RJ1-570 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
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	article
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
title	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_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_sort	hemorrhage during induction chemotherapy in neuroblastoma: additional risk factors in high-risk patients
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/88b22044d91e47e88c3228e5caa30ffb
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Hemorrhage During Induction Chemotherapy in Neuroblastoma: Additional Risk Factors in High-Risk Patients

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