Abstract：
Patients with high-risk neuroblastoma (HR-NB) exhibit suboptimal 5-year survival rates, leading to a widespread international preference for high-intensity chemotherapeutic regimens in these children. We analyzed the incidence and risk factors for complications during induction chemotherapy in children with HR-NB and tried to assist clinicians in predicting such complications and optimizing therapeutic strategy. The clinical data of children with HR-NB admitted to our hospital from January 2007 to December 2019 were retrospectively analyzed. The incidence, characteristics, and risk factors of complications (infection, hemorrhage, and chemotherapy-related adverse reactions (CRAR)) requiring hospitalization during induction chemotherapy in these children were explored. (1) A total of 108 patients with HR-NB were included in the final analysis. The overall infection rate was 92.6% (100/108), with the highest incidence of 71.3% observed during the first cycle. FN, bacterial infection, as well as fungal infection were common infectious complications in children with HR-NB during induction chemotherapy. (2) The overall hemorrhage rate was 24.1% (26/108), with the highest incidence of 14.8% also observed in the first cycle. Among the children with hemorrhage, there were 72% with bone marrow involved, while 65.0% of them had a high vanillylmandelic acid (VMA) value. And children with hemorrhage also exhibited neuron-specific enolase (NSE) ≥ 200 µg/L in 88.5% of cases and lactic dehydrogenase (LDH) ≥ 1000U/L in 73.1% of cases. (3) The incidence of CRAR rate was 100%, and 99.1% (107/108) patients experienced myelosuppression. The incidence of myelosuppression peaked in the third cycle, reaching up to 85.2%. Most children suffered severe myelosuppression existed with bone marrow metastases (76.3%), abnormal VMA (67.5%), and LDH ≥ 1000 U/L (60%). (4) Non-myelosuppressive adverse effects were observed in 75.9% children (82/108), with the highest incidence occurring in the third cycle at 42.6%. (5) Patients who experienced three types of complications had a lower median survival time (MST) of 54.4 months, a 3-year event-free survival (EFS) rate of (44.2 ± 10.7)%, and a 3-year overall survival (OS) rate of (75.8 ± 8.6)%, in comparison to those with only one or two complications, who had a higher MST of 59.5 months, a 3-year EFS rate of (73.5 ± 5.2)% (X2 = 10.457, P = 0.001), and a 3-year OS rate of (84.8 ± 4.1)% (X2 = 10.511, P = 0.001).
CONCLUSIONS: The presence of bone marrow involved and increased VMA were high-risk factors for infection, while NSE ≥ 200 µg/L and LDH ≥ 1000 U/L were high-risk factors for hemorrhage. For those children who had experienced severe myelosuppression, the presence of bone marrow metastases, increased VMA, and LDH ≥ 1000 U/L were their risk factors. The presence of bone involvement was a high-risk factor for children to have non-myelosuppressive adverse effects. Complications that arise during induction chemotherapy could negatively impact the children\'s prognosis and overall quality of life.
BACKGROUND: • The high-risk neuroblastoma (HR-NB) had a worse prognosis; there was a general international preference for high-intensity chemotherapeutic regimens in the induction phase to these children.
BACKGROUND: • We analyzed the incidence and risk factors of complications during induction chemotherapy in children with HR-NB and tried to help clinicians predict such complications and adopt optimized therapeutic strategy.
CONCLUSIONS: The presence of bone marrow involved and increased VMA were high-risk factors for infection, while NSE ≥ 200 µg/L and LDH ≥ 1000 U/L were high-risk factors for hemorrhage. For those children who had experienced severe myelosuppression, the presence of bone marrow metastases, increased VMA, and LDH ≥ 1000 U/L were their risk factors. The presence of bone involvement was a high-risk factor for children to have non-myelosuppressive adverse effects. Complications that arise during induction chemotherapy could negatively impact the children\'s prognosis and overall quality of life.
BACKGROUND: • The high-risk neuroblastoma (HR-NB) had a worse prognosis; there was a general international preference for high-intensity chemotherapeutic regimens in the induction phase to these children.
BACKGROUND: • We analyzed the incidence and risk factors of complications during induction chemotherapy in children with HR-NB and tried to help clinicians predict such complications and adopt optimized therapeutic strategy.
摘要：
高危神经母细胞瘤（HR-NB）患者的5年生存率不理想，导致国际上普遍倾向于在这些儿童中使用高强度化疗方案。我们分析了HR-NB患儿诱导化疗期间并发症的发生率和危险因素，并试图帮助临床医生预测此类并发症并优化治疗策略。回顾性分析我院2007年1月至2019年12月收治的HR-NB患儿的临床资料。发病率，特点,和并发症的危险因素(感染，出血,研究了这些儿童在诱导化疗期间需要住院治疗的化疗相关不良反应(CRAR)。(1)108例HR-NB患者纳入最终分析。总感染率为92.6%(100/108),在第一个周期中观察到的最高发生率为71.3%。FN,细菌感染,以及真菌感染是HR-NB患儿诱导化疗期间常见的感染性并发症.(2)总体出血率为24.1%(26/108),在第一个周期中也观察到最高的发生率为14.8%。在出血的儿童中，有72%的人涉及骨髓，其中65.0％的人具有较高的香草扁桃酸（VMA）值。在88.5%的病例中，出血儿童的神经元特异性烯醇化酶（NSE）≥200µg/L，在73.1%的病例中，乳酸脱氢酶（LDH）≥1000U/L。(3)CRAR发生率为100%,99.1%(107/108)的患者出现骨髓抑制。骨髓抑制的发生率在第三个周期达到峰值，达85.2%。大多数儿童患有严重的骨髓抑制，存在骨髓转移（76.3％），异常VMA（67.5%），LDH≥1000U/L(60%)。（4）75.9%的儿童（82/108）观察到非骨髓抑制不良反应，最高的发病率发生在第三个周期，为42.6%。（5）出现三种并发症的患者中位生存时间（MST）较低，为54.4个月，3年无事件生存率（EFS）为（44.2±10.7）％，3年总生存率（OS）为（75.8±8.6）％，与只有一两个并发症的人相比，MST较高，为59.5个月，3年EFS率为（73.5±5.2）％（X2=10.457，P=0.001），3年OS率为（84.8±4.1）％（X2=10.511，P=0.001）。
结论：骨髓受累和VMA升高是感染的高危因素，而NSE≥200µg/L和LDH≥1000U/L是出血的高危因素.对于那些经历过严重骨髓抑制的儿童，骨髓转移的存在，增加VMA，LDH≥1000U/L是其危险因素。骨受累是儿童发生非骨髓抑制性不良反应的高危因素。诱导化疗期间出现的并发症可能会对儿童的预后和整体生活质量产生负面影响。
背景：•高危神经母细胞瘤（HR-NB）的预后较差；对于这些儿童，国际上普遍倾向于在诱导期采用高强度化疗方案。
背景：•我们分析了HR-NB患儿诱导化疗期间并发症的发生率和危险因素，并试图帮助临床医生预测此类并发症并采取优化的治疗策略。
结论：骨髓受累和VMA升高是感染的高危因素，而NSE≥200µg/L和LDH≥1000U/L是出血的高危因素.对于那些经历过严重骨髓抑制的儿童，骨髓转移的存在，增加VMA，LDH≥1000U/L是其危险因素。骨受累是儿童发生非骨髓抑制性不良反应的高危因素。诱导化疗期间出现的并发症可能会对儿童的预后和整体生活质量产生负面影响。
背景：•高危神经母细胞瘤（HR-NB）的预后较差；对于这些儿童，国际上普遍倾向于在诱导期采用高强度化疗方案。
背景：•我们分析了HR-NB患儿诱导化疗期间并发症的发生率和危险因素，并试图帮助临床医生预测此类并发症并采取优化的治疗策略。
