title: Acute changes in blood pressure in patients with neuroblastoma treated with ¹³¹I-metaiodobenzylguanidine (MIBG).
abstract: BACKGROUND
  Iodine-131-metaiodobenzylguanidine ((131)I-MIBG) provides targeted radiotherapy for children with neuroblastoma. The aim of our study was to evaluate systematically the acute effects of (131)I-MIBG on blood pressure in patients with neuroblastoma and to identify possible predictors of hypertension.
  
  
  METHODS
  We conducted a retrospective chart review of neuroblastoma patients who were treated with (131)I-MIBG between January 1, 1999 and June 1, 2012 at the University of California, San Francisco. Clinical data for 172 patients with neuroblastoma, receiving 218 administrations of (131)I-MIBG, were collected. The primary endpoint was development of systolic blood pressure above the 95th percentile for age. Logistic regression with generalized estimating equations to account for multiple administrations in some subjects was used to identify bivariate and multivariate predictors of hypertension.
  
  
  RESULTS
  Of the 218 administrations of (131)I-MIBG, 112 (51.3%) were associated with at least one episode of systolic hypertension during or after the (131)I-MIBG infusion. The majority of these acute elevations in blood pressure resolved within 48 hours of the infusion. Only six administrations in five patients required nifedipine administration to lower blood pressure. Younger age (P = 0.012), lower eGFR (P = 0.047), and elevated blood pressure measurements immediately before infusion began (P = 0.010) were all independently associated with risk of treatment-associated hypertension.
  
  
  CONCLUSIONS
  Acute elevations in blood pressure are common after therapeutic doses of (131) I-MIBG. Elevations in blood pressure typically occur only within the first 48 hours after (131)I-MIBG administration. Blood pressure monitoring during this period of risk is recommended.
authors.affiliation: Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, California 94143-0106, USA.
authors.forename: Thalia
authors.initials: T
authors.lastname: Wong
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Matthay
authors.forename: W John
authors.initials: WJ
authors.lastname: Boscardin
authors.forename: Randall A
authors.initials: RA
authors.lastname: Hawkins
authors.forename: Paul R
authors.initials: PR
authors.lastname: Brakeman
authors.forename: Steven G
authors.initials: SG
authors.lastname: DuBois
mesh_terms: D019797:3-Iodobenzylguanidine / Q000008:administration & dosage / Q000009:adverse effects; D000293:Adolescent; D000367:Age Factors; D001794:Blood Pressure / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000188:drug therapy / Q000503:physiopathology; D007223:Infant; D008297:Male; D009447:Neuroblastoma / Q000188:drug therapy* / Q000503:physiopathology*; D009543:Nifedipine / Q000008:administration & dosage; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D019797:3-Iodobenzylguanidine; D009543:Nifedipine
keywords: MIBG; hypertension; neuroblastoma