Thrombosis in pediatric cancer: identifying the risk factors to improve care

Abstract

Cancer-associated thromboembolism (TE) is now a frequent complication in children. The reported prevalence varies from up to 16% of symptomatic to 40% of asymptomatic TE in children with cancer. Compared to the general pediatric population, children with cancer who develop TE have an increased risk of death, TE recurrence, TE-related morbidity and higher potential for utilization of health care resources. TE is preventable with anticoagulation therapy. With over 80% cure rates of childhood cancer, strategies for prevention as well as for early diagnosis and optimal treatment of TE in children with cancer are of major importance. An understanding of the risk factors predisposing children with cancer for development of TE will facilitate development of preventive and therapeutic strategies.

Keywords::

• cancer
• central venous line
• children
• leukemia
• lymphoma
• prediction model
• solid tumors
• thromboembolism

Financial & competing interests disclosure

This work is supported by C¹⁷ Research Network and Childhood Cancer Foundation/Candlelighters Canada, and Coast to Coast Against Cancer. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Cancer-associated thrombosis is increasingly detected in children with different types of cancers.

• • Considering the different biology of pediatric malignancies compared to adult cancers, the pathophysiology of cancer-associated thromboembolism in children is different.

• • Although central venous line is an important risk factor, over 50% of symptomatic thromboembolism are unrelated to central lines.

• • Age is an independent risk factor for development of thrombosis with adolescents and young adults having higher risk compared to younger children.

• • Children with leukemia, lymphoma and sarcoma are more likely to suffer from cancer-associated thrombosis.

• • Chemotherapeutic agents like asparaginase and steroids are shown to increase the risk of thrombosis. Thus, the risk of thrombosis especially in children with acute lymphoblastic leukemia is likely dependent on the chemotherapy protocol used.

• • Role of inherited thrombophilia in increasing the risk of thrombosis is children with cancer is not yet defined.

• • Development of prediction model in children is an important but challenging task.

Notes