Cardiovascular events and treatment of children with high risk medulloblastoma

Alessandra Cuomo; Valentina Mercurio; Manuela Pugliese; Maria Capasso; Serena Ruotolo; Anita Antignano; Carlo G Tocchetti; Annalisa Passariello

doi:10.1016/j.eclinm.2021.101251

Cardiovascular events and treatment of children with high risk medulloblastoma

EClinicalMedicine. 2021 Dec 31:43:101251. doi: 10.1016/j.eclinm.2021.101251. eCollection 2022 Jan.

Authors

Affiliations

¹ Department of Translational Sciences, Federico II University, Via Pansini 5, Naples 80131, Italy.
² Department of Pediatric Oncology, Santobono-Pausilipon Hospital, Naples, Italy.
³ Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy.
⁴ Interdepartmental Center for Clinical and Translational Research (CIRCET), Federico II University, Naples, Italy.
⁵ Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy.
⁶ Department of Translational Medical Sciences, Inherited and Rare Cardiovascular Disease, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy.

Abstract

Background: Children with high-risk medulloblastoma are treated with chemotherapeutic protocols which may affect heart function. We aimed to assesscardiovascular events (CVE) in children with medulloblastoma/primitive neuroectodermal tumors (PNET).

Methods: We retrospectively collected data from a case series of 22 children with high-risk medulloblastoma/PNET admitted to the Santobono-Pausilipon Hospital, Naples, Italy from 2008 to 2016. All patients received the Milan HART protocol for high-risk brain malignancies as first line treatment (induction phase), followed by a consolidation phase with Thiotepa and hematopoietic stem cells transplantation, except for 1 patient who received the Milan HART as second line therapy. Four patients also received second line treatment, while 4 patients also received maintenance therapy. Patients underwent cardiac examination, including ECG, echocardiography and serum biomarkers, before antineoplastic treatment initiation and then when clinically needed. Six patients developed CVE (CVE group); 16 patients had no CVE (NO-CVE group).

Findings: In the CVE group, 3 patients presented acute CVE during chemotherapy (2 patients with left ventricular (LV) dysfunction, 1 patient with arterial hypertension), while 3 patients presented chronic CVE after chemotherapy completion (2 patients with LV dysfunction, 1 patient with ectopic atrial tachycardia). After a 51 months median follow-up, 9 patients died: 4 from the CVE group (in 2 cases heart failure-related deaths) and 5 from the NO-CVE group (progression of disease).

Interpretation: A relevant percentage of children treated for medulloblastoma/PNET develops CVE. Heart failure potentially due to chemotherapy may represent a cause of death. Hence, in these patients, strict cardiac surveillance is essential.

Funding: No funding was associated with this study.

Keywords: Cardiovascular events; Children medulloblastoma/PNET; Milan HART.