Fibrinolytic abnormality associated with progression of pediatric solid tumor

Thrombosis and hemorrhage are serious complications of pediatric solid tumor, and enhanced fibrinolysis associated with disseminated intravascular coagulation (DIC) is often observed. Fibrinolytic enzymes also play an important role in metastasis. Limited information is available, however, on the assessment of overall hemostatic function in children with malignant solid tumor.

We have investigated the comprehensive hemostatic potential in these circumstances using simultaneous thrombin/plasmin generation assay (T/P-GA). Endogenous thrombin potential (T-EP) and plasmin peak height (P-Peak) were measured using T/P-GA in six children newly diagnosed with solid tumor at regular intervals during chemotherapy at the present hospital from 2013 to 2016. Four patients with metastasis were defined as the advanced group, and the other patients were defined as the non-advanced group.

In the advanced group, the ratio of P-Peak to normal was higher than the slightly increased ratio of T-EP to normal (range, 1.2-2.1 vs 1.1-1.5, respectively). In the non-advanced group, however, the P-Peak ratio was relatively lower than the slightly increased T-EP ratio (range, 1.0-1.5 vs 1.1-1.5, respectively). Fibrin-fibrinogen degradation product was elevated in all patients except in one non-advanced brain tumor patient during this induction therapy (maximum, 11.6-161 μg/mL).

Uncontrolled fibrinolysis together with an imbalance between coagulation and fibrinolytic potential might lead to DIC. Further research is warranted to clarify comprehensive hemostatic function in pediatric patients with solid tumors to establish optimal supportive therapy, and possibly limit tumor progression in these critical disorders.