Epidemiology and clinical risk factors predisposing to thromboembolism in children with cancer

PURPOSE: The prevalence and risk factors for thromboembolism (TE) in children with cancer are largely unknown. This retrospective cohort study aims to determine the epidemiology of TE and to identify potential risk factors for TE in children with cancer. METHODS: We used logistic regression to determine the association of age (<10 years vs. > or =10 years), gender, type of cancer, presence or absence of intra-thoracic disease (mediastinal mass or any primary or metastatic pulmonary disease), type of central venous line (CVL) and CVL-dysfunction (difficulty of blood draw, infusion or documented CVL infection) on the risk of developing TE. RESULTS: Fifty-seven of 726 patients [7.9%; 95% confidence intervals (CI); 6.0,10.0] developed TE; children with brain tumors (n = 201) had significantly lower prevalence of TE (0.5%; P < 0.001). Older patients had increased risk of developing TE compared to younger patients [Odds ratios (OR) 1.8; 95% CI; 1.0,3.2; P = 0.036]. Children with acute lymphoblastic leukemia (ALL) (OR 4.6; 95% CI; 1.8, 12.3; P = 0.002), lymphoma (OR 3.8; 95% CI; 1.3, 11.1; P = 0.016), and sarcoma (OR 4.3; 95% CI; 1.4, 13.3; P = 0.012) had an increased risk of TE. Subgroup analyses showed that patients with CVL-dysfunction and intra-thoracic disease had a higher prevalence of TE compared to those without CVL-dysfunction (22.8% vs. 8.8%; 95% CI; 4.0, 24.3; P = 0.006) and intra-thoracic disease (18.0% vs. 6.1%; 95% CI; 2.4, 21.4; P = 0.02). CONCLUSIONS: TE is common in children with cancer. Age and type of cancer are independent risk factors for TE in children with non-CNS cancers. CVL-dysfunction and intra-thoracic disease are significantly associated with the diagnosis of TE.