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Risk Model Predictive of Severe Anemia Requiring RBC Transfusion After Chemotherapy in Pediatric Solid Tumor Patients

From the Pediatric Oncology Unit, INSERM U590, the Statistics department, and the Medical Oncology Unit, Centre Léon Bérard, Lyon Cedex, France.

Address reprint requests to Perrine Marec-Berard, MD, Centre Léon Bérard, 28 rue Laennec, 69373 Lyon Cedex 08, France; e-mail: marec{at}lyon.fnclcc.fr.

Purpose: Severe anemias requiring RBC transfusions is a frequent complication of chemotherapy. A model elaborated by Ray-Coquard et al in adults pointed to three independent risk factors for RBC transfusion: performance status (PS) more than 1, hemoglobin less than 12 g/dL, and prechemotherapy absolute lymphocyte count (ALC) 700/µL. This model is tested on a pediatric population.

Patients and Methods: One hundred nineteen children with solid tumors consecutively admitted for conventional chemotherapy throughout 1 year were included. The study end point was the RBC-transfusion risk in the month following chemotherapy. Only one course was considered for each patient. Age, sex, number of courses, platinum-containing regimens, PS, and hemoglobin and lymphocyte count at day 1 were tested in univariate and multivariate analyses.

Results: Thirty-one (26%) of 119 children required RBC transfusion within 31 days of chemotherapy. Three factors correlated to transfusion risk in the univariate analysis: PS more than 1 (P < .001), hemoglobin less than 12 g/dL (P = .007), and pretreatment ALC 700/µL (P < .001). In the multivariate analysis, hemoglobin less than 12 g/dL, PS more than 1, and ALC 700/µL were identified as independent factors predicting RBC transfusion. The calculated probability of receiving RBC transfusion within 31 days of chemotherapy was high with three risk factors (96%), intermediate with two risk factors (53% to 77%), low with one risk factor (10% to 26%), and very low when no risk factor was present (2%). The difference of transfusion needs was significant (P < .001).

Conclusion: The risk model elaborated for adults may also segregate children at high risk of postchemotherapy RBC transfusion, thus facilitating assessment of risk of transfusion and/or prophylactic erythropoietin support.

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