RISK FACTORS FOR HEARING LOSS IN PEDIATRIC ONCOLOGY PATIENTS

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RISK FACTORS FOR HEARING LOSS IN PEDIATRIC
ONCOLOGY PATIENTS

• Jennifer Dean, Sarah Boslaugh, Susan S. Hayashi,
  Catherine M. Albert, Roanne Karzon, Robert J.
  Hayashi
• Division of Pediatric Hematology/Oncology and the
  Department of Pediatrics, Washington University
  School of Medicine, Division of Audiology, St.
  Louis Childrens Hospital, St. Louis, MO

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Background

• Platinum-based chemotherapy are important agents
  in the treatment of childhood cancer.
• Ototoxicity from these agents is a significant
  problem.
• The hearing loss suffered is typically
  irreversible and often worsens with continued
  treatment.
• Not all patients treated with platinum-based
  chemotherapy develop hearing loss.
• The risk factors for platinum-induced hearing
  loss are not well described.

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Purpose

• To assess the risk factors associated with
  hearing loss secondary to platinum compounds
• To assess the natural history of platinum-induced
  hearing loss

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Methods

• Inclusion criteria
• Pediatric cancer patients treated with platinum
  containing regimens
• Retrospective chart review
• From 1993-2002
• Hearing evaluations were performed at SLCH
• Audiograms
• Reviewed by certified audiologist for reliability
• Hearing loss established using classification
  scheme by Brock et al (Medical Pediatric
  Oncology. 19(4) 295-300, 1991 )

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Brock Grade
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Methods

• The following risk factors were assessed
• Gender
• Age at diagnosis
• Race
• Diagnosis
• Use and dose of cisplatin
• Use and dose of carboplatin
• Radiation, including site of radiation
• Use and toxic levels of other ototoxic drugs
  (lasix, vancomycin, aminoglycosides)
• Use of ifosfamide
• Abnormal creatinine, GFR, and albumin
• History of bone marrow transplant

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Patient Characteristics
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Diagnoses
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Bivariate Analysis
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Multivariate Analysis
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Cisplatin Dose and Hearing Loss
Cumulative Censored
normal hearing
Cumulative CDDP Dose
Cumulative Censored
normal hearing
Cumulative CDDP Dose
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Timing of Cisplatin-induced Hearing Loss

• Majority of patients who received cisplatin
  developed hearing loss after therapy was
  completed (81)
• Average time to hearing loss from end of therapy
  104 days
• Range -395 699 days

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Conclusions

• Male gender and the use of cisplatin are
  significant risk factors for hearing loss
• Male gender as a risk factor in platinum-induced
  hearing loss is a new finding
• Possibility of the role of estrogen and estrogen
  receptors in the cochlea
• Cisplatin at any dose is a risk factor for
  hearing loss
• No safe dose
• No plateau effect was seen
• Patients need monitoring for hearing loss at
  least 1- 2 years from the end of therapy
• Other factors may be contributing to the late
  hearing loss in these patients

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Future Directions

• More studies addressing the impact of gender as a
  risk factor for hearing loss
• Role of estrogen in platinum-induced hearing loss
• Further investigation into late-onset hearing
  loss and the impact of noise exposure and other
  potential ototoxic agents