The association of mediastinal mass in the formation of thrombi in pediatric patients with non‐lymphoblastic lymphomas

Abstract

BACKGROUND:Children diagnosed with cancer are at a significantly higher risk of developing a thrombotic event (TE) compared to the general population. The rarity of these events makes it difficult to discern the specific risk factors; however, age, sex, presence of central venous lines, inherited thrombophilia and mediastinal mass may play a role. The primary aim of this study is to identify prognostic characteristics of children diagnosed with non-lymphoblastic lymphomas associated with a greater risk of developing a thrombotic event early on in their disease, with an increased focus on mediastinal mass characteristics. METHODS:Retrospective chart review of pediatric patients diagnosed with non-lymphoblastic lymphoma between 2004 and 2014 at St. Jude Children's Research Hospital.RESULTS: TE occurred in 8.5% (n=28/330) of individuals at a median of 21 days from diagnosis of a non-lymphoblastic lymphoma, with 60% of TEs occurring within 30 days of diagnosis. Of the variables evaluated, only presence of a PICC [OR: 3.14 (95% CI: 1.24-7.98; p=0.02)] and degree of superior vena cava (SVC) compression of >25% increased the odds of developing a TE [OR: 2.2 (95%CI: 1.01-4.93; p=0.048)]. CONCLUSION:Pediatric patients with non-lymphoblastic lymphoma are at increased risk of developing TEs. In contrast to previous studies, presence of a mediastinal mass alone was not associated with a higher risk of TE, but individuals with a mediastinal mass with 25% or greater degree of SVC compression were more likely to develop a TE. This finding highlights a high-risk group of children that may benefit from prophylactic anticoagulation.

Primary Thromboprophylaxis to Prevent Thrombotic Events in Pediatric Oncology Patients with a Malignant Mediastinal Mass.

“…In our study we observed a trend towards reduction in M-TE with primary thromboprophylaxis but was not statistically significant likely related to small cohort size. Furthermore, mediastinal mass associated TE incidence of 8.5%, has been reported with the odds increasing by 2.2 when the SVC was >25% compressed [8]. This is akin to our incidence of 9.2% with observed increase in SVC compression with M-TEs versus those without.…”

Central venous catheter–associated complications in pediatric patients diagnosed with Hodgkin lymphoma: implications for catheter choice

“…Since the risk of some complications might be higher during treatment (i.e., intensive use of CVC), the IRs per 1000 CVC-treatment days were also calculated, which still showed that the insertion of a SL PICC is associated with a significantly higher risk of (severe) complications and local infections in particular compared to a TIVAP. The high rate of complications associated with PICCs was also reported previously in adult patients with HL and pediatric oncology patients in general [1,[9][10][11][12][13]. Three studies did investigate risk factors for CVT (CVC and non-CVCrelated) specifically in pediatric patients with lymphoma.…”

“…However, general anesthesia is needed for insertion, sedation for removal, percutaneous punctures to access the port, and a larger scar will remain visible after removal, whereas these disadvantages do not apply to PICCs. On the other hand, higher incidence rates of mechanical failure, CVC-related infections, and CVC-related central venous thrombosis (CVT) have been associated with PICCs when compared to other CVC-types in a variety of adult and pediatric patients (i.e., oncology, intensive care unit, total parenteral nutrition) [1][2][3][4][5][6][7][8][9][10]. However, the incidence of all CVC-related complications for patients with HL specifically has not been described previously.…”

“…Based on studies in adults and children, the risk of CVCrelated CVTs has been described to be higher in patients with HL, compared to other oncology patients [3,9]. Suggested risk factors that may contribute to this difference are tumor-associated inflammation and compression of veins typically occurring in the upper body, the older age of patients, and frequent high-dose corticosteroid treatment, which are all known risk factors for thrombosis [1,3,[11][12][13][14][15]. Since pediatric patients with HL might be at a higher risk of CVC-related CVTs and since the risk of other CVC-related complications per CVC type for this patient group is currently unknown, it is of importance that the most optimal CVC for these children is identified.…”

Síndrome de vena cava superior en pediatría. Una revisión de la literatura

“…El estudio concluye que los individuos con una masa mediastínica con un 25% o más de grado de compresión de la VCS, tenían más probabilidades de desarrollar eventos trombóticos. Este hallazgo destaca un grupo de niños de alto riesgo que pueden beneficiarse de la anticoagulación profiláctica [28].…”