Risk model predictive of severe anemia requiring RBC transfusion after chemotherapy in pediatric solid tumor patients.
OBJECTIVE
Severe anemias requiring RBC transfusions is a frequent complication of chemotherapy. A model elaborated by Ray-Coquard et al in adults pointed to three independent risk factors for RBC transfusion: performance status (PS) more than 1, hemoglobin less than 12 g/dL, and prechemotherapy absolute lymphocyte count (ALC) < or = 700/microL. This model is tested on a pediatric population.


METHODS
One hundred nineteen children with solid tumors consecutively admitted for conventional chemotherapy throughout 1 year were included. The study end point was the RBC-transfusion risk in the month following chemotherapy. Only one course was considered for each patient. Age, sex, number of courses, platinum-containing regimens, PS, and hemoglobin and lymphocyte count at day 1 were tested in univariate and multivariate analyses.


RESULTS
Thirty-one (26%) of 119 children required RBC transfusion within 31 days of chemotherapy. Three factors correlated to transfusion risk in the univariate analysis: PS more than 1 (P <.001), hemoglobin less than 12 g/dL (P =.007), and pretreatment ALC < or = 700/microL (P <.001). In the multivariate analysis, hemoglobin less than 12 g/dL, PS more than 1, and ALC < or = 700/microL were identified as independent factors predicting RBC transfusion. The calculated probability of receiving RBC transfusion within 31 days of chemotherapy was high with three risk factors (96%), intermediate with two risk factors (53% to 77%), low with one risk factor (10% to 26%), and very low when no risk factor was present (2%). The difference of transfusion needs was significant (P <.001).


CONCLUSIONS
The risk model elaborated for adults may also segregate children at high risk of postchemotherapy RBC transfusion, thus facilitating assessment of risk of transfusion and/or prophylactic erythropoietin support.
Marec-Berard
Perrine
P
Pediatric Oncology Unit, INSERM U590, the Statistics department, and Centre Léon Bérard, Lyon Cedex, France. marec@lyon.fnclcc.fr
Blay
Jean Yves
JY
Schell
Matthias
M
Buclon
Murielle
M
Demaret
Corrine
C
Ray-Coquard
Isabelle
I
D000293:Adolescent; D000740:Anemia / Q000097:blood / Q000139:chemically induced* / Q000628:therapy*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017707:Erythrocyte Transfusion; D005260:Female; D006441:Hemoglobin A / Q000032:analysis; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
D000970:Antineoplastic Agents; D006441:Hemoglobin A