E-071 Neutropenia after intra-arterial chemotherapy for the treatment of retinoblastoma

Background and Purpose Intra-arterial chemotherapy (IAC) infusion for the treatment of intraocular retinoblastoma is an effective and relatively safe therapeutic option.1–3 However, one of the well described systemic complications following IAC is neutropenia.4 The purpose of this retrospective study is to examine the incidence of neutropenia over the course of treatment for each patient, and to further analyze if the incidence is affected by systemic chemotherapy or number of chemotherapeutic agents used for IAC. Methods We retrospectively identified 76 patients from a neurointerventional database spanning 10 years (March 2010 - August 2020) who underwent 214 cycles of IAC. Patient demographics, treatment course, angiographic technique as well as pre and post procedural complete blood counts were extracted from the medical record. Neutropenia, including all grades I-IV, is defined by an absolute neutrophil count (ANC) equal to or less than 1.5 x 10(9)/L. Eleven patients who did not obtain a post-procedural complete blood count during their treatment course were excluded. The presence of postprocedural neutropenia was further subdivided based on whether systemic intravenous chemotherapy was administered as well as according to the number of intra-arterial chemotherapeutic agents. Results The overall incidence of neutropenia was 62% in our total patient cohort. There was no statistically significant difference between the incidence of neutropenia in patients who did and did not receive systemic chemotherapy. The majority of patients received two chemotherapeutic agents (melphalan and topotecan), of which 58% and 54% of patients experienced neutropenia with and without systemic chemotherapy, respectively. The highest incidence of neutropenia was 100%, in five patients who received systemic chemotherapy and a three agent intra-arterial regimen (melphalan, topotecan, carboplatin). Conclusion Neutropenia is a systemic toxicity in more than half of patients who receive IAC infusion for intraocular retinoblastoma, and does not significantly differ in patients who do and do not receive systemic chemotherapy. References Ammanuel S, Alexander MD, Damato B, et al. Improved procedural safety following protocol changes for selective ophthalmic arterial infusion of chemotherapy for treatment of ocular retinoblastoma. Interv Neuroradiol. 2018;24(3):345–350. Yousef YA, Soliman SE, Astudillo PPP, et al. Intra-arterial Chemotherapy for Retinoblastoma: A Systematic Review. JAMA Ophthalmol. 2016;134(5):584–591. Monroy JE, Orbach DB, VanderVeen D. Complications of intra-arterial chemotherapy for retinoblastoma. Semin Ophthalmol. 2014;29(5–6):429–433. Dunkel IJ, Shi W, Salvaggio K, et al. Risk factors for severe neutropenia following intra-arterial chemotherapy for intra-ocular retinoblastoma. PLoS One. 2014;9(10):e108692. Disclosures A. Baker: None. S. Ammanuel: None. M. Caton: None. K. Narsinh: None. A. Ashfar: None. A. Banerjee: None. D. Cooke: None. C. Dowd: None. M. Amans: None. V. Halbach: None. R. Higashida: None. S. Hetts: None.