Epidemiology of venous thrombosis in children with cancer

Abstract

SummaryThere has been an extensive body of research focusing on the epidemiology of thrombosis in adult cancer populations; however, there is significantly less knowledge about thrombosis in paediatric cancer populations. Thrombosis is diagnosed with increasing frequency in children being treated for cancer, and there is an urgent need to increase our understanding of the epidemiology of thrombosis in this population. Currently, there are no guidelines for identification of high-risk groups, prophylaxis or management of thrombotic complications in paediatric cancer patients. We reviewed the available literature regarding the epidemiology, mechanisms, risk factors, prophylaxis and outcomes of thrombosis in children with cancer and identified areas that require further research. The reported incidence of symptomatic venous thromboembolism (VTE) in children with cancer ranges between 2.1% and 16%, while the incidence of asymptomatic events is approximately 40%. Approximately 30% of VTE in this population is associated with central venous lines (CVL). The most common location of VTE is upper and lower extremity deep venous thrombosis (43 to 50% of events, respectively), while 50% of events in ALL patients occur in the central nervous system. Key characteristics that increase the risk of thrombosis include the type of cancer, age of the patient, the presence of a CVL, presence of pulmonary/intra thoracic disease, as well as the type of chemotherapy. Outcomes for paediatric cancer patients with VTE include post-thrombotic syndrome, pulmonary embolism, recurrent thromboembolism, destruction of upper venous system and death. Prospective studies aimed at enabling risk stratification of patients are required to facilitate development of paediatric specific recommendations related to thromboprophylaxis in this population.

Optimal management of venous thromboembolism in adolescent and young adult oncology patients

“…Among pediatric patients, adolescents were reported to have the highest incidence of VTE at 94 cases per 10,000 hospital admissions, and those with a malignancy had the highest rate of first time and subsequent VTE. [11][12][13][14][15] A similar trend has been reported in the adult literature, with a notable increase in the rates of VTE in adults with cancer over the last several decades. 16 Approximately 20% of reported cases of VTE among adults occur in patients with cancer.…”

Oncogenes and Clotting Factors: The Emerging Role of Tumor Cell Genome and Epigenome in Cancer-Associated Thrombosis

“…4,40 The molecular landscapes of pediatric brain tumors are vastly different than those in adults and are increasingly well characterized, 78,[91][92][93] but they are infrequently discussed in the context of CAT. 38,94,95 While this is understandable due to a lesser clinical burden of thrombosis in children, the biological effects of hemostatic perturbations are likely relevant. For example, in pediatric medulloblastoma (MB), the expression of TF, PAR-1, FX, and other elements of the vascular coagulome and angiome is highly divergent between the four main disease subtypes: sonic hedgehog (SHH), wingless (WNT), group 3, and group 4.…”

BSH Guideline: management of thrombotic and haemostatic issues in paediatric malignancy

“…Studies using radiological screening to diagnose asymptomatic thromboses have identified rates of up to 40% (Mitchell et al , ; Albisetti et al , ), although the significance of many of these asymptomatic events is unclear. The incidence of symptomatic VTE varies according to cancer subtype, being more common in acute lymphoblastic leukaemia (ALL) (5% from a meta‐analysis published in 2006, range 3–14%), sarcoma (7–13%) and lymphoma (2–17%) and less common in children with other malignancies (Caruso et al , ; Nowak‐Göttl et al , ; Piovesan et al , ; Van Ommen & Chan, ).…”