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Splenectomy, splenic radiation linked to infection-related mortality among childhood cancer survivors
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Splenectomy and splenic radiation increased risk for infection-related mortality among childhood cancer survivors, according to data from the Childhood Cancer Survivor Study.
“Many survivors of childhood cancer are asplenic, either as a result of primary surgical treatment of their disease or for historical staging of Hodgkin lymphoma,” Brent R. Weil, MD, assistant in surgery at Boston Children’s Hospital and professor of surgery at Harvard Medical School, and colleagues wrote. “In addition, those who received splenic radiation are at risk for developing impaired splenic function. Although the asplenic state — anatomic or functional — is known to be associated with increased risk for severe infections, long-term implications for survivors of childhood cancer are poorly understood.”
Researchers evaluated late infection-related mortality among 20,026 5-year survivors of childhood cancer diagnosed between 1970 and 1999. All study participants were aged 21 years or younger at the time of diagnosis.
Median follow-up was 26 years.
1,354 survivors (6.8%) underwent splenectomy within 5 years of diagnosis, and 46% (n = 9,442) underwent splenic radiation without splenectomy.
Sixty-two study participants died.
Investigators reported cumulative incidence of infection related mortality of 1.5% (95% CI, 0.7-2.2) by 35 years after splenectomy, and 0.6% (95% CI, 0.4-0.8) after splenic radiation.
Splenectomy appeared associated with late infection-related mortality independent of other factors (RR = 7.7; 95% CI, 3.1-19.1).
Researchers observed a dose-response relationship between splenic radiation and increased risk for late infection-related mortality (0.1 to 9.9 Gy, RR = 2; 95% CI, 0.9-4.5; 10 Gy to 19.9 Gy, RR = 5.5; 95% CI, 1.9-15.4; and 20 Gy or more, RR = 6; 95% CI, 1.8-20.2).
Exposure to high-dose alkylator chemotherapy also appeared independently associated with infection-related mortality (RR = 1.9; 95% CI, 1.1-3.4).
“Examination of this large cohort of survivors of cancer reveals that both splenectomy and radiotherapy delivered to a field including the spleen are associated with increased risk [for] late infection-related mortality,” the researchers wrote. “This risk may be potentiated with advancing age. ... Future guidelines for care of individuals with asplenia or who are at risk for functional hyposplenism should consider these findings that identify a high-risk population for late mortality.” – by Andy Polhamus
Disclosures: Weil reports no relevant financial disclosures. Please see the study for a list of all other authors’ relevant financial disclosures.
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