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Pediatric cancer-associated thrombosis: Analysis from a tertiary care cancer center in India

Nidhi Dhariwal1,2, Venkata Rama Mohan Gollamudi1,2, K P Sangeetha3

  • 1Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.

Pediatric Blood & Cancer
|November 19, 2022
PubMed

Insights

Pediatric cancer-associated thrombosis (PCAT) affects 2.4% of children, predominantly older children with hematolymphoid malignancies. While most cases resolve with treatment, PCAT negatively impacts event-free survival, underscoring the need for preventative strategies.

Area of Science:

  • Oncology
  • Pediatrics
  • Hematology

Background:

  • Thrombotic events (TEs) are well-documented in adult cancer patients, but data on pediatric cancer-associated thrombosis (PCAT) remain limited.
  • This study prospectively investigated the incidence, characteristics, and outcomes of PCAT in children with malignancies.

Purpose of the Study:

  • To determine the incidence and risk factors of pediatric cancer-associated thrombosis.
  • To analyze the clinical presentation, management, and outcomes of TEs in children undergoing cancer treatment.

Main Methods:

  • A prospective analysis of children under 15 years with confirmed malignancies treated at a tertiary cancer center in India.
  • Data collection included demographic information, malignancy type, TE occurrence, site, management with low molecular weight heparin (LMWH), and survival outcomes.
  • Statistical analysis identified factors associated with PCAT, including age, malignancy type, and treatment risk group.

Main Results:

  • The incidence of PCAT was 2.44% (150/6132 children), with TEs occurring most frequently during chemotherapy (74.0%) and in the central nervous system (39.3%).
  • Hematolymphoid malignancies (3.23%) were more prone to PCAT than solid tumors (1.58%). Acute myeloid leukemia (AML) and non-Hodgkin lymphoma showed higher incidences.
  • Older age (>10 years), AML, and non-Hodgkin lymphoma were significant risk factors for TEs. PCAT was associated with reduced 2-year event-free survival in hematolymphoid malignancies.

Conclusions:

  • PCAT occurs in 2.4% of pediatric cancer patients, primarily affecting older children with hematolymphoid malignancies early in their treatment course.
  • Most TEs resolved with LMWH treatment, and mortality directly attributable to TEs was low (4.66%).
  • PCAT significantly impacts event-free survival in hematolymphoid malignancies, highlighting the critical need for effective prevention strategies in this vulnerable population.
Abstract

Keywords:
malignancypediatricthromboembolismthrombosis

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