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An event is serious (based on the ICH definition) when the patient outcome is:
* death
* life-threatening
* hospitalisation
* disability
* congenital anomaly
* other medically important event
A 4-year-old boy developed neutropenia and thrombocytopenia during chemotherapy with cisplatin, doxorubicin and dexrazoxane for hepatoblastoma.
The boy presented to the emergency department with acute abdominal pain and hepatomaegaly. After investigations, he was diagnosed with hepatoblastoma (epithelial subtype). He started receiving chemotherapy with SIOPEL-4 based regimen comprising cisplatin, doxorubicin and dexrazoxane [dosages and routes not stated]. The first block of therapy was tolerated well. However, he developed neutropenia, cough and fever during the second block. Following an examination, he was diagnosed with SARS-CoV-2 infection. Then, he was admitted. He received empirical treatment with unspecified broad spectrum antibacterials [antibiotics]. He successfully completed the second block of the SIOPEL-4 based regimen. Further investigations showed no evidence of extrahepatic metastatic disease. Thus, he was considered for liver transplantation. Subsequently, he received block-3 of chemotherapy without complications. His liver lesions did not regress to a resectable level, and there was no SARS-CoV-2 infection. He started receiving first consolidation block of the SIOPEL-4 based regimen, and underwent a liver transplantation with choledochocholedochostomy. His post-transplant immunosuppressive therapy comprised of prednisone, methylprednisolone, prednisolone and tacrolimus. Subsequently, he developed neutropenia and thrombocytopenia secondary to the SIOPEL-4 based chemotherapy regimen [duration of treatments to reaction onsets not stated]. His absolute neutrophil count never decline below 1 000 /mm3. Therefore, no medical therapies were needed. On post-transplant day 11, he was discharged. Further, the post-transplant immunosuppression was not altered compared to standard protocol [outcomes not stated].
Reference
- Goss MB, et al. Liver Transplant in a Recently COVID-19 Positive Child with Hepatoblastoma. Pediatric Transplantation : 26 Sep 2020. Available from: URL: 10.1111/petr.13880 [DOI] [PMC free article] [PubMed]