Mesothelioma can affect the lining of any organ of the body. The most common type of mesothelioma, pleural mesothelioma, affects the lining of the lungs. As it is the most common form of the disease, much of the research that is done centres around pleural mesothelioma.
The second most common type of mesothelioma is peritoneal mesothelioma, this affects the lining of the abdomen.
Researchers in Singapore have been looking into peritoneal mesothelioma patients who develop problems with their blood cells after having surgery with HIPEC.
Surgery with HIPEC
HIPEC surgery, also called heated or hyperthermic intraperitoneal chemotherapy, involves heated chemotherapy drugs being delivered directly into the abdominal cavity. This is often used in combination with cytoreductive surgery and is currently the most effective treatment for peritoneal mesothelioma.
Before this treatment was available, the average survival rate for peritoneal mesothelioma was around six months, with HIPEC surgery, patients can survive for more than five years.
Currently, more than half of patients who have HIPEC surgery go on to develop problems with their blood cells.
The study
The research team studied 15 years’ worth of peritoneal mesothelioma surgery data. This comprised 220 patients between 2001 and 2016 who had had cytoreductive surgery with HIPEC, either for peritoneal mesothelioma or another type of abdominal cancer.
They found that older patients and patients who had already had chemotherapy, were most likely to develop blood cell problems after HIPEC.
The blood cell problems, medically known as haematological toxicities, can include issues with white blood cells, red blood cells, bleeding, clotting, platelets and proteins.
The most common blood cell problem after HIPEC for peritoneal mesothelioma was thrombocytopenia. This is more commonly known as a low platelet count and results in the patient not being able to form clots. Over 37% of patients reviewed developed thrombocytopenia.
They found that 15% of patients developed leukopenia following HIPEC surgery. This is a drop in leukocytes (white blood cells) that fight infection.
Neutropenia, a drop in another type of white blood cell, was found in around 4% of patients.
Short-term problems
The blood cell problems tended to develop within just a few days of surgery and, at most, lasted for 16 days, so the problems were thankfully short-lived.
Patients over the age of 60 were most at risk of developing such issues.
Knowing the risks helps post-surgery monitoring
This is important research, as knowing which patients are most at risk of developing blood cell problems after surgery, will assist in ensuring they have the relevant monitoring, and medical teams can be on alert for specific issues.
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Source:
Wong, EYT, at al, “Hematological toxicities associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy”, November 6, 2019, Asia-Pacific Journal of Clinical Oncology, Epub ahead of print, https://onlinelibrary.wiley.com/doi/abs/10.1111/ajco.13275