Risk factors for severe neutropenia following intra-arterial chemotherapy for intra-ocular retinoblastoma

Intra-arterial chemotherapy is a promising strategy for intra-ocular retinoblastoma. Neutropenia is the most commonly encountered systemic toxicity and in this study we aimed to determine the risk factors associated with the development of severe (≥ grade 3) neutropenia. Retrospective review of 187...

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Bibliographic Details
Published in:PloS one 2014-10, Vol.9 (10), p.e108692
Main Authors: Dunkel, Ira J, Shi, Weiji, Salvaggio, Kim, Marr, Brian P, Brodie, Scott E, Gobin, Y Pierre, Abramson, David H
Format: Article
Language:English
Subjects:
Age
Antineoplastic Agents, Alkylating - administration & dosage
Antineoplastic Agents, Alkylating - adverse effects
Antineoplastic Agents, Alkylating - therapeutic use
Blood tests
Cancer
Cancer therapies
Carboplatin
Chemotherapy
Child, Preschool
Confidence intervals
Cycle ratio
Humans
Infant
Infusions, Intra-Arterial
Intravenous administration
Medical prognosis
Medicine and Health Sciences
Melphalan
Melphalan - administration & dosage
Melphalan - adverse effects
Melphalan - therapeutic use
Multivariate analysis
Neurosurgery
Neutropenia
Neutropenia - chemically induced
Neutropenia - pathology
Neutrophils - drug effects
Neutrophils - pathology
Patients
Pediatrics
Regression analysis
Retina
Retina - drug effects
Retinal Neoplasms - drug therapy
Retinoblastoma
Retinoblastoma - drug therapy
Retrospective Studies
Risk analysis
Risk Factors
Statistical analysis
Topotecan
Toxicity
Tumors
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Summary:Intra-arterial chemotherapy is a promising strategy for intra-ocular retinoblastoma. Neutropenia is the most commonly encountered systemic toxicity and in this study we aimed to determine the risk factors associated with the development of severe (≥ grade 3) neutropenia. Retrospective review of 187 evaluable cycles of melphalan-containing intra-arterial chemotherapy from the first three cycles administered to 106 patients with intra-ocular retinoblastoma from May 2006 to June 2011. Cycles were considered to be evaluable if (1) blood count results were available in the 7 to 14 days post-treatment interval and (2) concurrent intravenous chemotherapy was not administered. Toxicity was assessed via the Common Terminology Criteria for Adverse Events version 4.0. 54 cycles (29%) were associated with grade 3 (n = 43) or grade 4 (n = 11) neutropenia. Multivariate stepwise logistic regression revealed that a higher melphalan dose (>0.40 mg/kg) was significantly associated with severe neutropenia during all 3 cycles (odds ratio during cycle one 4.11, 95% confidence interval 1.33-12.73, p = 0.01), but the addition of topotecan and/or carboplatin were not. Prior treatment with systemic chemotherapy was not associated with severe neutropenia risk in any analysis. Intra-arterial melphalan-based chemotherapy can cause severe neutropenia, especially when a dose of greater than 0.40 mg/kg is administered. Further study with a larger sample may be warranted.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0108692