title: Risk factors for severe neutropenia following intra-arterial chemotherapy for intra-ocular retinoblastoma.
abstract: OBJECTIVE
  Intra-arterial chemotherapy is a promising strategy for intra-ocular retinoblastoma. Neutropenia is the most commonly encountered systemic toxicity and in this study we aimed to determine the risk factors associated with the development of severe (≥ grade 3) neutropenia.
  
  
  METHODS
  Retrospective review of 187 evaluable cycles of melphalan-containing intra-arterial chemotherapy from the first three cycles administered to 106 patients with intra-ocular retinoblastoma from May 2006 to June 2011. Cycles were considered to be evaluable if (1) blood count results were available in the 7 to 14 days post-treatment interval and (2) concurrent intravenous chemotherapy was not administered. Toxicity was assessed via the Common Terminology Criteria for Adverse Events version 4.0.
  
  
  RESULTS
  54 cycles (29%) were associated with grade 3 (n = 43) or grade 4 (n = 11) neutropenia. Multivariate stepwise logistic regression revealed that a higher melphalan dose (>0.40 mg/kg) was significantly associated with severe neutropenia during all 3 cycles (odds ratio during cycle one 4.11, 95% confidence interval 1.33-12.73, p = 0.01), but the addition of topotecan and/or carboplatin were not. Prior treatment with systemic chemotherapy was not associated with severe neutropenia risk in any analysis.
  
  
  CONCLUSIONS
  Intra-arterial melphalan-based chemotherapy can cause severe neutropenia, especially when a dose of greater than 0.40 mg/kg is administered. Further study with a larger sample may be warranted.
authors.affiliation: Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States of America; Department of Pediatrics, New York Presbyterian Hospital Weill Cornell Medical College, New York, NY, United States of America.
authors.forename: Ira J
authors.initials: IJ
authors.lastname: Dunkel
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States of America.
authors.forename: Weiji
authors.initials: W
authors.lastname: Shi
authors.affiliation: Department of Neurosurgery, New York Presbyterian Hospital Weill Cornell Medical College, New York, NY, United States of America.
authors.forename: Kim
authors.initials: K
authors.lastname: Salvaggio
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States of America; Department of Ophthalmology, New York Presbyterian Hospital Weill Cornell Medical College, New York, NY, United States of America.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Marr
authors.affiliation: Department of Ophthalmology, Mount Sinai Medical Center, New York, NY, United States of America.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Brodie
authors.affiliation: Department of Neurosurgery, New York Presbyterian Hospital Weill Cornell Medical College, New York, NY, United States of America.
authors.forename: Y Pierre
authors.initials: YP
authors.lastname: Gobin
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States of America; Department of Ophthalmology, New York Presbyterian Hospital Weill Cornell Medical College, New York, NY, United States of America.
authors.forename: David H
authors.initials: DH
authors.lastname: Abramson
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007261:Infusions, Intra-Arterial; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D009503:Neutropenia / Q000139:chemically induced* / Q000473:pathology; D009504:Neutrophils / Q000187:drug effects / Q000473:pathology; D012160:Retina / Q000187:drug effects; D019572:Retinal Neoplasms / Q000188:drug therapy*; D012175:Retinoblastoma / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan