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Scully M, Antun A, Cataland SR, Coppo P, Dossier C, Biebuyck N, Hassenpflug WA, Kentouche K, Knöbl P, Kremer Hovinga JA, López-Fernández MF, Matsumoto M, Ortel TL, Windyga J, Bhattacharya I, Cronin M, Li H, Mellgård B, Patel M, Patwari P, Xiao S, Zhang P, Wang LT. Recombinant ADAMTS13 in Congenital Thrombotic Thrombocytopenic Purpura. N Engl J Med 2024; 390:1584-1596. [PMID: 38692292 DOI: 10.1056/nejmoa2314793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND Congenital thrombotic thrombocytopenic purpura (TTP) results from severe hereditary deficiency of ADAMTS13. The efficacy and safety of recombinant ADAMTS13 and standard therapy (plasma-derived products) administered as routine prophylaxis or on-demand treatment in patients with congenital TTP is not known. METHODS In this phase 3, open-label, crossover trial, we randomly assigned patients in a 1:1 ratio to two 6-month periods of prophylaxis with recombinant ADAMTS13 (40 IU per kilogram of body weight, administered intravenously) or standard therapy, followed by the alternate treatment; thereafter, all the patients received recombinant ADAMTS13 for an additional 6 months. The trigger for this interim analysis was trial completion by at least 30 patients. The primary outcome was acute TTP events. Manifestations of TTP, safety, and pharmacokinetics were assessed. Patients who had an acute TTP event could receive on-demand treatment. RESULTS A total of 48 patients underwent randomization; 32 completed the trial. No acute TTP event occurred during prophylaxis with recombinant ADAMTS13, whereas 1 patient had an acute TTP event during prophylaxis with standard therapy (mean annualized event rate, 0.05). Thrombocytopenia was the most frequent TTP manifestation (annualized event rate, 0.74 with recombinant ADAMTS13 and 1.73 with standard therapy). Adverse events occurred in 71% of the patients with recombinant ADAMTS13 and in 84% with standard therapy. Adverse events that were considered by investigators to be related to the trial drug occurred in 9% of the patients with recombinant ADAMTS13 and in 48% with standard therapy. Trial-drug interruption or discontinuation due to adverse events occurred in no patients with recombinant ADAMTS13 and in 8 patients with standard therapy. No neutralizing antibodies developed during recombinant ADAMTS13 treatment. The mean maximum ADAMTS13 activity after recombinant ADAMTS13 treatment was 101%, as compared with 19% after standard therapy. CONCLUSIONS During prophylaxis with recombinant ADAMTS13 in patients with congenital TTP, ADAMTS13 activity reached approximately 100% of normal levels, adverse events were generally mild or moderate in severity, and TTP events and manifestations were rare. (Funded by Takeda Development Center Americas and Baxalta Innovations; ClinicalTrials.gov number, NCT03393975.).
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Affiliation(s)
- Marie Scully
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Ana Antun
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Spero R Cataland
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Paul Coppo
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Claire Dossier
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Nathalie Biebuyck
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Wolf-Achim Hassenpflug
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Karim Kentouche
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Paul Knöbl
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Johanna A Kremer Hovinga
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - M Fernanda López-Fernández
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Masanori Matsumoto
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Thomas L Ortel
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Jerzy Windyga
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Indranil Bhattacharya
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Michael Cronin
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Hong Li
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Björn Mellgård
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Munjal Patel
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Parth Patwari
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Shan Xiao
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Pinghai Zhang
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
| | - Linda T Wang
- From the Department of Haematology, University College London Hospitals, London (M.S.); the Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta (A.A.); the Department of Internal Medicine, Ohio State University, Columbus (S.R.C.); the Department of Hematology and National Reference Center for Thrombotic Microangiopathies, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université (P.C.), the Department of Pediatric Nephrology, Robert Debré Hospital, AP-HP and University of Paris (C.D.), and the Department of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, AP-HP (N.B.) - all in Paris; the Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg (W.-A.H.), and the Section of Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Jena, Jena (K.K.) - both in Germany; the Department of Medicine 1, Division of Hematology and Hemostasis, Medical University of Vienna, Vienna (P.K.); the Department of Hematology and Central Hematologic Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland (J.A.K.H.); the Hematology and Hemotherapy Service, Mother and Child Hospital, Biomedical Research Institute of A Coruña, University Hospital Complex of A Coruña, A Coruña, Spain (M.F.L.-F.); the Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan (M.M.); the Division of Hematology, Department of Medicine, and Department of Pathology, Duke University, Durham, NC (T.L.O.); the Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland (J.W.); and Takeda Development Center Americas, Cambridge, MA (I.B., M.C., H.L., B.M., M.P., P.P, S.X., P.Z., L.T.W.)
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Peyvandi F, Mannucci PM, Garagiola I, El-Beshlawy A, Elalfy M, Ramanan V, Eshghi P, Hanagavadi S, Varadarajan R, Karimi M, Manglani MV, Ross C, Young G, Seth T, Apte S, Nayak DM, Santagostino E, Mancuso ME, Sandoval Gonzalez AC, Mahlangu JN, Bonanad Boix S, Cerqueira M, Ewing NP, Male C, Owaidah T, Soto Arellano V, Kobrinsky NL, Majumdar S, Perez Garrido R, Sachdeva A, Simpson M, Thomas M, Zanon E, Antmen B, Kavakli K, Manco-Johnson MJ, Martinez M, Marzouka E, Mazzucconi MG, Neme D, Palomo Bravo A, Paredes Aguilera R, Prezotti A, Schmitt K, Wicklund BM, Zulfikar B, Rosendaal FR. A Randomized Trial of Factor VIII and Neutralizing Antibodies in Hemophilia A. N Engl J Med 2016; 374:2054-64. [PMID: 27223147 DOI: 10.1056/nejmoa1516437] [Citation(s) in RCA: 326] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The development of neutralizing anti-factor VIII alloantibodies (inhibitors) in patients with severe hemophilia A may depend on the concentrate used for replacement therapy. METHODS We conducted a randomized trial to assess the incidence of factor VIII inhibitors among patients treated with plasma-derived factor VIII containing von Willebrand factor or recombinant factor VIII. Patients who met the eligibility criteria (male sex, age <6 years, severe hemophilia A, and no previous treatment with any factor VIII concentrate or only minimal treatment with blood components) were included from 42 sites. RESULTS Of 303 patients screened, 264 underwent randomization and 251 were analyzed. Inhibitors developed in 76 patients, 50 of whom had high-titer inhibitors (≥5 Bethesda units). Inhibitors developed in 29 of the 125 patients treated with plasma-derived factor VIII (20 patients had high-titer inhibitors) and in 47 of the 126 patients treated with recombinant factor VIII (30 patients had high-titer inhibitors). The cumulative incidence of all inhibitors was 26.8% (95% confidence interval [CI], 18.4 to 35.2) with plasma-derived factor VIII and 44.5% (95% CI, 34.7 to 54.3) with recombinant factor VIII; the cumulative incidence of high-titer inhibitors was 18.6% (95% CI, 11.2 to 26.0) and 28.4% (95% CI, 19.6 to 37.2), respectively. In Cox regression models for the primary end point of all inhibitors, recombinant factor VIII was associated with an 87% higher incidence than plasma-derived factor VIII (hazard ratio, 1.87; 95% CI, 1.17 to 2.96). This association did not change in multivariable analysis. For high-titer inhibitors, the hazard ratio was 1.69 (95% CI, 0.96 to 2.98). When the analysis was restricted to recombinant factor VIII products other than second-generation full-length recombinant factor VIII, effect estimates remained similar for all inhibitors (hazard ratio, 1.98; 95% CI, 0.99 to 3.97) and high-titer inhibitors (hazard ratio, 2.59; 95% CI, 1.11 to 6.00). CONCLUSIONS Patients treated with plasma-derived factor VIII containing von Willebrand factor had a lower incidence of inhibitors than those treated with recombinant factor VIII. (Funded by the Angelo Bianchi Bonomi Foundation and others; ClinicalTrials.gov number, NCT01064284; EudraCT number, 2009-011186-88.).
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Affiliation(s)
- Flora Peyvandi
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Pier M Mannucci
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Isabella Garagiola
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Amal El-Beshlawy
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Mohsen Elalfy
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Vijay Ramanan
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Peyman Eshghi
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Suresh Hanagavadi
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Ramabadran Varadarajan
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Mehran Karimi
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Mamta V Manglani
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Cecil Ross
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Guy Young
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Tulika Seth
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Shashikant Apte
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Dinesh M Nayak
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Elena Santagostino
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Maria Elisa Mancuso
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Adriana C Sandoval Gonzalez
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Johnny N Mahlangu
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Santiago Bonanad Boix
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Monica Cerqueira
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Nadia P Ewing
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Christoph Male
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Tarek Owaidah
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Veronica Soto Arellano
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Nathan L Kobrinsky
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Suvankar Majumdar
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Rosario Perez Garrido
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Anupam Sachdeva
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Mindy Simpson
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Mathew Thomas
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Ezio Zanon
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Bulent Antmen
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Kaan Kavakli
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Marilyn J Manco-Johnson
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Monica Martinez
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Esperanza Marzouka
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Maria G Mazzucconi
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Daniela Neme
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Angeles Palomo Bravo
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Rogelio Paredes Aguilera
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Alessandra Prezotti
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Klaus Schmitt
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Brian M Wicklund
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Bulent Zulfikar
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
| | - Frits R Rosendaal
- From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico (F.P., P.M.M., E.S., M.E.M.), and Department of Pathophysiology and Transplantation, Università degli Studi di Milano (F.P., P.M.M., I.G.), Milan, Clinica Medica II, Azienda Ospedaliera di Padova, Centro Emofilia, Padua (E.Z.), and Ematologia, Unità Operativa Diagnostica Speciale e Terapia delle Malattie dell'Emostasi e della Trombosi, Università Sapienza, Policlinico Umberto I, Rome (M.G.M.) - all in Italy; the Pediatric Hematology Department, Cairo University Pediatric Hospital (A.E.-B.), and Department of Pediatrics, Faculty of Medicine, Ain Shams University (M.E.), Cairo; Jehangir Clinical Development Center, Department of Hematology, Jehangir Hospital Premises (V.R.), and Sahyadri Speciality Hospital (S.A.), Pune, Jagadguru Jayadeva Murugarajendra Medical College, Davangere (S.H.), Center for Blood Disorders, Chennai (R.V.), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (M.V.M.); St. John's Medical College Hospital, Bangalore (C.R.), All India Institute of Medical Sciences, Department of Hematology (T.S.), and Pediatric Hematology Oncology and Bone Marrow Transplantation, Institute for Child Health, Sir Ganga Ram Hospital (A.S.), New Delhi, Melaka-Manipal Medical College, Manipal University, Manipal (D.M.N.), and Kerala Institute of Medical Science, Trivandrum (M.T.) - all in India; the Congenital Pediatric Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran (P.E.), and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz (M.K.) - both in Iran; Children's Hospital Los Angeles, Los Angeles (G.Y.), and City of Hope National Medical Center, Duarte (N.P.E.) - both in California; Hospital de Especialidades Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Monterrey (A.C.S.G.), an
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