Thromb Haemost 2018; 118(09): 1646-1655
DOI: 10.1055/s-0038-1668543
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Thromboembolism Incidence and Risk Factors in Children with Cancer: A Population-Based Cohort Study

Marie-Claude Pelland-Marcotte
1  Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Jason D. Pole
2  Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
3  Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
,
Ketan Kulkarni
4  Division of Haematology-Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
,
Uma Athale
5  Division of Haematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
,
David Stammers
6  Division of Pediatric Haematology/Oncology, Department of Pediatrics, Royal University Hospital, University of Saskatchewan, Saskatoon, Canada
,
Christine Sabapathy
7  Division of Pediatric Haematology/Oncology, Department of Pediatrics, McGill University, Montréal, Québec, Canada
,
Jessica Halparin
8  Division of Haematology/Oncology/BMT, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
,
Leonardo R. Brandão
1  Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Lillian Sung
1  Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
3  Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
› Author Affiliations
Further Information

Publication History

02 May 2018

11 July 2018

Publication Date:
13 August 2018 (eFirst)

Abstract

There is conflicting information about the epidemiology of thromboembolism (TE) in paediatric oncology. Objectives were to describe the incidence and risk factors of TE in children with cancer. We included all children with cancer less than 15 years of age diagnosed from 2001 to 2016, treated at one of the 12 Canadian paediatric centres outside of Ontario and entered into the Cancer in Young People-Canada database. Potential risk factors for TE were evaluated using Cox proportional hazards regression stratified by haematological malignancies versus solid tumours. Factors associated with vascular access- and non-vascular access-related TE were compared using chi-square or Fisher's exact tests. Of the 7,471 children included, 283 experienced TE requiring medical intervention; cumulative incidence of TE at 5 years was 3.8 ± 0.2% and 0.36% ± 0.07% for life-threatening or fatal TE. For haematological malignancies, the following factors were associated with TE in multivariable regression: age < 1 year, 5 to 9.99 years and 10 to 14.99 years (relative to age 1–4.99 years), haematopoietic stem cell transplant (hazard ratio [HR] = 1.49, 95% confidence interval [CI], 1.00–2.32), anthracyclines (HR = 2.21, 95% CI, 1.12–4.37) and asparaginase (HR = 1.68, 95% CI, 1.15–2.44). For solid tumours, obesity (HR = 1.92, 95% CI, 1.01–3.68), surgery (HR = 2.70, 95% CI, 1.44–5.08), radiation (HR = 47.51, 95% CI, 24.01–94.01), anthracyclines (HR = 2.74, 95% CI, 1.29–5.82) and platinum agents (HR = 2.26, 95% CI, 1.19–4.28) were associated with TE. Life-threatening and fatal TEs were more common among non-vascular access TEs (14.5% vs. 3.3% p = 0.001). In a population-based cohort, 4% of children with cancer developed a clinically significant TE. Accurate risk stratification tools are needed specific to malignancy type.