An Update on the Treatment of Hemangiomas in Children With Interferon Alfa-2a

Abstract

In pediatric patients with massive or life-threatening hemangiomas, interferon alfa-2a therapy is an effective treatment option. However, neurological evaluation before and during therapy with interferon alfa-2a should be performed owing to a significant incidence of neurological abnormalities (28%). Although all children with neurological findings demonstrated neurological recovery after discontinuation of therapy, we have changed our protocol and now more gradually increase the dosage of interferon alfa-2a up to 3 million U/m2 per day. The effect of this modification on the development of neurological abnormalities has not yet been determined.

Diagnosis and Management of Infantile Hemangioma

“…Although some have reported response rates of up to 90% in steroid-resistant lesions, the effect is gradual in onset, and rebound can occur on discontinuation. 254 Up to 20% of children treated with interferon-a appear to develop spastic diplegia. 255 This complication tends to occur later in the treatment course and may be irreversible.…”

Refractive and structural changes in infantile periocular capillary haemangioma treated with propranolol

“…21 In cases of steroid-resistant lesions, second-line therapy with interferon-á and vincristine had an almost 100% success rate, but adverse reactions ranged from minor to very severe. 8,22 In 2008, Léauté-Labrèze et al 23 reported that propranolol administered for decreased cardiac output in a child with a capillary haemangioma led to permanent regression of the lesion. This finding was confirmed in another report of 11 children treated with propranolol for capillary haemangioma.…”

Increased Tie2 Expression, Enhanced Response to Angiopoietin-1, and Dysregulated Angiopoietin-2 Expression in Hemangioma-Derived Endothelial Cells

“…3,4 However, not all hemangiomas respond to these drugs and neurological toxicity has been associated with interferon-␣ administration. 5,6 The recent demonstration of ectopic expression of type 3 iodothyronine deiodinase in hemangioma, which in at least one child caused hypothyroidism, 7 underscores the need for novel therapy.…”