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Recurrence rate of infantile hemangioma after oral propranolol therapy

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Abstract

Oral propranolol is the treatment of choice for infantile hemangiomas. The growth relapse rate following oral propranolol therapy is not well established in the literature. The present study aimed at determining predictors of growth relapse of infantile hemangiomas after discontinuation of oral propranolol therapy. A retrospective analysis was performed of all cases of infantile hemangiomas aged ≤ 12 months undergoing oral propranolol therapy in a 6-year period. Of the 198 cases, regrowth after oral propranolol therapy was observed in 35 patients (18%). Facial hemangiomas showed a higher (p = 0.003) relapse rate as compared with other hemangiomas (27 out of 107 facial cases vs. 8 out of 91 with other location, respectively 25% and 8.8%). Of 35 growth relapses cases, 66% of cases (23 in total, 18 facial and 5 otherwise located hemangiomas) underwent a second cycle of oral propranolol therapy (median length of treatment 3 months, interquartile range 2–3). All cases had a successful outcome, either after a single cycle oral propranolol therapy (163 cases, 82%), or in case of regrowth, after a second therapy cycle (23 cases, 12%) or further conservative management (12 cases, 6%).

Conclusion: Facial infantile hemangiomas relapse earlier and more frequently after oral propranolol therapy. We suggest to closely monitor these patients, as a second cycle of propranolol may be indicated. Prolonged oral propranolol therapy might be considered for facial infantile hemangiomas.

What is Known:

• Oral propranolol is the treatment of choice for infantile hemangiomas.

• The growth relapse rate following oral propranolol is not well established.

What is New:

• The present study points out that facial infantile hemangioma relapse earlier and more frequently after oral propranolol therapy.

• Patients with facial infantile hemangiomas should be monitored after propranolol therapy discontinuation.

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Data availability

N/A

Abbreviations

IH:

Infantile hemangioma

OPT:

Oral propranol therapy

HIF-1α:

Hypoxia-inducible factor-1-α

VEGF:

Vascular endothelial growth factor

IGF-2:

insulin-like growth factor 2

GLUT-1:

Glucose transporter 1

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Author information

Authors and Affiliations

  1. Division of Pediatric Surgery, Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany

    Giovanni Frongia, Ji-Oun Byeon & Patrick Günther

  2. Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany

    Arianeb Mehrabi

Authors
  1. Giovanni Frongia
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  2. Ji-Oun Byeon
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  3. Arianeb Mehrabi
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  4. Patrick Günther
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Contributions

Study conception and design: Giovanni Frongia.

Data acquisition: Giovanni Frongia, Ji-Oun Byeon.

Analysis and data interpretation: Giovanni Frongia, Ji-Oun Byeon.

Drafting of the manuscript: Giovanni Frongia, Ji-Oun Byeon.

Critical revision: Arianeb Mehrabi, Patrick Günther.

Accountable for all aspects of the work: G. Frongia.

Corresponding author

Correspondence to Giovanni Frongia.

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The authors declare that they have no conflict of interest.

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The local ethics committee approved this study.

Ethical approval was obtained from the institutional review board.

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Not necessary, in accordance with institutional ethic review board, due to retrospective study design.

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Communicated by Gregorio Paolo Milani

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Frongia, G., Byeon, JO., Mehrabi, A. et al. Recurrence rate of infantile hemangioma after oral propranolol therapy. Eur J Pediatr 180, 585–590 (2021). https://doi.org/10.1007/s00431-020-03872-5

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  • DOI: https://doi.org/10.1007/s00431-020-03872-5

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