1 / 8

Infantile Hemangioma: Natural History & Treatment

Infantile Hemangioma: Natural History & Treatment. - Involution phase: 50% of infantile hemangiomas show complete involution by age 5 years & 70% by age 7 years.

imaran
Download Presentation

Infantile Hemangioma: Natural History & Treatment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Infantile Hemangioma: Natural History & Treatment - Involution phase: 50% of infantile hemangiomas show complete involution by age 5 years & 70% by age 7 years. -  Medical care of clinically significant hemangiomas has been limited to a few medications: corticosteroids, interferon alfa, vincristine, & imiquimod. - Beta-blockers, most specifically Propranolol, have recently been serendipitously been shown to induce involution of infantile hemangiomas.

  2. Discovery of Propranolol as a treatment for             infantile hemangiomas. Initial case report: -A 9 wk old baby with a rapidly growing segmental facial hemangioma & ocular complications s/p 4 wk course of corticosteroids. - The baby developed high output cardiac failure & propranolol was started.  - 7 days later, the hemangioma was significantly smaller.  At 9 months of age, visual functionwas restored. Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo J-B, Taïeb A. Propranolol for severe hemangiomas of infancy. N Engl J Med 2008;358:2649-2651

  3. Follow-up Case Series: Patients with a life-threatening laryngeal hemangiomas. • - N = 32 patients • Mean age = 4 months • 1 patient dropped out because of respiratory side-effects from propranolol. • Immediate effects on color and growth were noted in all patients & were especially dramatic in cases of dyspnea, hemodynamic compromise or palpebral occlusion. Sans, V. et al. Pediatrics 2009;124:e423-e431

  4. Mechanisms of Action - β2-adrenergic receptors are present on endothelial cells of infantile hemangiomas. (1) • β-Adrenergic receptor stimulation activates signal transduction pathways of angiogenic factors such as VEGF or bFGF. • Blockade of angiogenic factors thought to cause vasoconstriction of vessels within hemangiomas. - A study of the use of β-blockers for treatment of cardiac hypertrophy revealed that carvedilol reversed levels of both protein and mRNA for VEGF to baseline values. (2) 1. M. Cario-André, PhD, C.L-L., L.J. Nissen, PhD, A.T., F. Majurier, PhD, unpublished data 2. Shyu KG, Liou JY, Wang BW, Fang WJ, Chang H. Carvedilol prevents cardiac hypertrophy and overexpression of hypoxia-inducible factor-1 and vascular endothelial growth factor in pressure-overloaded rat heart. J Biomed Sci. 2005;12 (2):409 –420

  5. Is Propranolol the 1st line treatment for infantile hemangiomas? • Not yet! It is currently only used in severe cases & several questions need to be addressed before it can be more widely used. - What is the optimal dosing, dose escalation, & length of therapy? May recur if stopped to early. - What are the risks in patient subsets that may have different vascular characteristics-such as in PHACES syndrome [posterior fossa, hemangioma, arterial, cardiac, & sternal abnormality]? - There is an ongoing RCT comparing Propranolol to placebo that should provide answers to some of these questions.

  6. Demonstrative Case: Patient shortly after birth, Jan 2009.

  7. Demonstrative Case: Patient 6 Weeks after Propanolol, March 2009. Significant involution with fibrofatty replacement has already occurred.

  8. Demonstrative Case: Patient 9 months after Propanolol, October 2009. The lesion has involuted, clinically resolved and there is minimal stranding of the retro-ocular fat and thickening of eyelids.

More Related