1 INTRODUCTION
Advanced neuroblastoma is an aggressive childhood cancer with a poor
prognosis. Multidisciplinary treatment, including multiagent
chemotherapy, surgery, radiotherapy, hematopoietic stem cell
transplantation, and immunotherapy, aimed at minimizing residual disease
has increased the long-term survival rate of patients with high-risk
neuroblastoma to 60%. Among the variety of treatment modalities,
multiagent chemotherapy consisting of vinca alkaloid, anthracyclines,
alkylators, and platinum is still the mainstay1.
Accurate control of adverse events during the initial induction
chemotherapy is necessary but difficult because the condition of the
patients is frequently unstable due to the huge tumor burden both in the
abdomen and metastatic sites.
Tumor lysis syndrome (TLS) is a well-known metabolic adverse event
resulting from the contents of large numbers of lysed cancer cells being
released into the blood stream. Although it occurs during induction
chemotherapy for highly chemosensitive malignancies, such as acute
leukemia and malignant lymphoma, it is also sometimes observed in
advanced neuroblastomas. The immune response provoked by TLS is
particularly interesting for its potential role in acute respiratory
events (ARE) that are encountered albeit rarely during induction
chemotherapy in some patients with advanced neuroblastoma. The incidence
of acute respiratory distress syndrome (ARDS), which is considered to be
a severe form of ARE occurring during induction chemotherapy for
neuroblastoma, is reportedly one in eighty-six
(1.2%)3 to one in forty-six
(2.2%)2 based on previous case series.
We herein hypothesized that ARE have the same etiology as TLS, and that
their risk can be estimated using biologic parameters related to TLS.
The present, retrospective, cohort study conducted at two, high-volume
centers in Japan, aimed to test these hypotheses.