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Khan M, Iftikhar R, Ghafoor T, Hussain F, Chaudhry QUN, Mahmood SK, Shahbaz N, Khan MA, Khattak TA, Shamshad GU, Rehman J, Ali S, Shah Z, Rafae A, Farhan M, Anwer F, Ahmed P. Allogeneic hematopoietic stem cell transplant in rare hematologic disorders: a single center experience from Pakistan. Bone Marrow Transplant 2020; 56:863-872. [PMID: 33184452 DOI: 10.1038/s41409-020-01126-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/14/2020] [Accepted: 10/30/2020] [Indexed: 11/09/2022]
Abstract
Management of rare hematological disorders pose unique diagnostic and therapeutic challenges due to unusual occurrence and limited treatment options. We retrospectively identified 45 patients receiving matched related donor transplant for rare hematological disorders from 2006 to 2019. Patients were divided into two groups (1) malignant and (2) non malignant. The malignant disorder group included four patients while the nonmalignant group included 41 patients divided into immune dysregulation (n = 23), bone marrow failure (n = 10), metabolic (n = 5), and bleeding diathesis (n = 3). Twenty-six (57.8%) patients received myeloablative conditioning (MAC) and 16 (35.6%) received reduced intensity conditioning (RIC), while 3 (6.6%) patients with severe combined immunodeficiency received stem cell infusion alone without conditioning. The cumulative incidence (CI) of grade II-IV acute GVHD (aGVHD) was 39.1% (n = 18) and chronic GVHD (cGVHD) 15.2% (n = 7). There was no primary graft failure while CI of secondary graft failure was 9%. Overall survival (OS) and disease-free survival (DFS) was 82.2% and 77.8% respectively. Group wise OS was 75% in the malignant group, 82.6% in the immune dysregulation group, 80% in patients with metabolic disorders and bone marrow failure, while 100% in patients with bleeding diathesis. This retrospective analysis shows that hematopoietic stem cell transplant can be a feasible treatment option for rare hematological disorders.
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Affiliation(s)
- Maryam Khan
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | - Raheel Iftikhar
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan.
| | - Tariq Ghafoor
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | - Fayyaz Hussain
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | | | | | - Nighat Shahbaz
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | - Mehreen Ali Khan
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | | | | | - Jahanzeb Rehman
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | - Sundas Ali
- Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Zunaira Shah
- Pgy-1Weiss Memorial Hospital Chicago, Chicago, IL, USA
| | - Abdul Rafae
- Department of Internal Medicine, McLaren Flint Michigan State University, Chicago, IL, USA
| | - Muhammad Farhan
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | - Faiz Anwer
- Tausig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Parvez Ahmed
- Quaid-e-Azam International Hospital, Islamabad, Pakistan
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Nuti S, Seghieri C, Niccolai F, Vasta F, Grazzini G. Comparing regional models of congenital bleeding disorders: preliminary steps in the Italian context. BMC Res Notes 2017; 10:229. [PMID: 28651638 PMCID: PMC5485622 DOI: 10.1186/s13104-017-2552-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 06/19/2017] [Indexed: 11/12/2022] Open
Abstract
Background Among these diseases, congenital bleeding disorders (CBD) represent a significant societal burden in terms of high morbidity costs and health outcomes. In Italy, the organization and provision of health care is a regional responsibility and regions must assure equity and quality to all their residents. This is also true for CBD care which is provided by 54 multidisciplinary Hemophilia Treatment Centers (HTCs) distributed among the regions. With the present study, we intend to stimulate a debate on the effect that the decentralization process have in the delivery of services to CBD patients across Italy. Methods The available comparable measures of caseloads per center and interregional patient mobility, as proxies of quality and responsiveness of the regional network of HTCs, were first analyzed for the using data from the Italian Hemophilia Centers Association for the year 2012. Results Nine thousand one hundred and thirty four Italian residents with CBD received care in at least one of the Italian HTC in 2012. Preliminary findings suggested room for improvement in health care delivery for CBD patients. In 2012, 16 HTCs out of 51 (31.4%) treated a number of patients under the minimum requirement for treatment center accreditation (10 severe patients). Moreover, data on interregional patient mobility highlighted differences in the ability of each region to retain its own residents or to attract residents from other regions. Conclusions Preliminary study results showed significant disparities among regions in terms of volumes and mobility of residents with CBDs that cannot be completely explained by the different geographical characteristics. Therefore, the central government should consider taking concrete measures to bridge the gap between regions to assure access to quality care for all individuals with CBD independently from where they live and therefore to move toward a more integrated and homogeneous national network of care centers. Typology of disease, patients’ needs, and cost for outcomes, should have high priority on the political agenda. For CBD patients, even in a federal healthcare system, the national government should have the global responsibility to guaranteeing uniform levels of quality care over the country and overcome local institutions when necessary.
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Affiliation(s)
- Sabina Nuti
- Laboratorio Management e Sanità, Istituto di Management, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56125, Pisa, Italy
| | - Chiara Seghieri
- Laboratorio Management e Sanità, Istituto di Management, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56125, Pisa, Italy.
| | - Francesco Niccolai
- Laboratorio Management e Sanità, Istituto di Management, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56125, Pisa, Italy
| | - Federica Vasta
- Laboratorio Management e Sanità, Istituto di Management, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56125, Pisa, Italy
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The need for a next-generation public health response to rare diseases. Genet Med 2016; 19:489-490. [PMID: 27787501 DOI: 10.1038/gim.2016.166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/07/2016] [Indexed: 11/08/2022] Open
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Paulukonis ST, Harris WT, Coates TD, Neumayr L, Treadwell M, Vichinsky E, Feuchtbaum LB. Population based surveillance in sickle cell disease: methods, findings and implications from the California registry and surveillance system in hemoglobinopathies project (RuSH). Pediatr Blood Cancer 2014; 61:2271-6. [PMID: 25176145 DOI: 10.1002/pbc.25208] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 07/10/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND There are no population-based surveillance systems to determine prevalence, impact or outcomes in sickle cell disease (SCD). Estimates of the SCD population in California range broadly from 4,500 to 7,000, and little is known about their health status, health care utilization or health outcomes. A surveillance strategy was implemented using diverse data sources to develop a multi-dimensional, state-based surveillance system for SCD that includes adults and children and describes utilization, treatment and outcomes. PROCEDURE Data from California newborn screening, inpatient and emergency room records, Medi-Cal/Medicaid claims and two SCD special care centers were collected for 2004-2008. A multi-step, iterative linkage process was used to link and de-duplicate these data sources, and case definitions were used to categorize cases. RESULTS After linking and de-duplicating, there were 1,975 confirmed cases of SCD, 3,159 probable cases as well as 8,024 possible cases. Among individual data sources, newborn screening and data from clinics contributed the greatest number of unique cases to the total. Select analyses of utilization and treatments for the population are described. CONCLUSIONS Using linked existing data sources, an estimate of the statewide count of the SCD population is possible. The approach can be used to create an in-depth health status profile of the affected population by aggregating utilization, treatment, and outcomes data including mortality and morbidity information. This effort sets the stage for development of an on-going, state-based surveillance system.
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Richardson LC, Parker CS, Tsai J. Blood disorders and public health. Am J Prev Med 2014; 47:656-7. [PMID: 25245798 PMCID: PMC4476383 DOI: 10.1016/j.amepre.2014.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/13/2014] [Accepted: 07/18/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Lisa C Richardson
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia.
| | - Christopher S Parker
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - James Tsai
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
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Beckman MG, Hulihan MM, Byams VR, Oakley MA, Reyes N, Trimble S, Grant AM. Public health surveillance of nonmalignant blood disorders. Am J Prev Med 2014; 47:664-8. [PMID: 25245796 PMCID: PMC4484743 DOI: 10.1016/j.amepre.2014.07.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/26/2014] [Accepted: 07/21/2014] [Indexed: 10/24/2022]
Abstract
Nonmalignant blood disorders currently affect millions of Americans, and their prevalence is expected to grow over the next several decades. This is owing to improvements in treatment leading to increased life expectancy of people with hereditary conditions, like sickle cell disease and hemophilia, but also the rising occurrence of risk factors for venous thromboembolism. The lack of adequate surveillance systems to monitor these conditions and their associated health indicators is a significant barrier to successfully assess, inform, and measure prevention efforts and progress toward national health goals. CDC is strengthening surveillance activities for blood disorders by improving and developing new methods that are tailored to best capture and monitor the epidemiologic characteristics unique to each disorder. These activities will provide a robust evidence base for public health action to improve the health of patients affected by or at risk for these disorders.
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Affiliation(s)
- Michele G Beckman
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia.
| | - Mary M Hulihan
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Vanessa R Byams
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Meredith A Oakley
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Nimia Reyes
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Sean Trimble
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Althea M Grant
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
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Colombatti R, Perrotta S, Samperi P, Casale M, Masera N, Palazzi G, Sainati L, Russo G. Organizing national responses for rare blood disorders: the Italian experience with sickle cell disease in childhood. Orphanet J Rare Dis 2013; 8:169. [PMID: 24139596 PMCID: PMC4231397 DOI: 10.1186/1750-1172-8-169] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/09/2013] [Indexed: 02/01/2023] Open
Abstract
Background Sickle cell disease (SCD) is the most frequent hemoglobinopathy worldwide but remains a rare blood disorder in most western countries. Recommendations for standard of care have been produced in the United States, the United Kingdom and France, where this disease is relatively frequent because of earlier immigration from Africa. These recommendations have changed the clinical course of SCD but can be difficult to apply in other contexts. The Italian Association of Pediatric Hematology Oncology (AIEOP) decided to develop a common national response to the rising number of SCD patients in Italy with the following objectives: 1) to create a national working group focused on pediatric SCD, and 2) to develop tailored guidelines for the management of SCD that could be accessed and practiced by those involved in the care of children with SCD in Italy. Methods Guidelines, adapted to the Italian social context and health system, were developed by 22 pediatric hematologists representing 54 AIEOP centers across Italy. The group met five times for a total of 128 hours in 22 months; documents and opinions were circulated via web. Results Recommendations regarding the prevention and treatment of the most relevant complications of SCD in childhood adapted to the Italian context and health system were produced. For each topic, a pathway of diagnosis and care is detailed, and a selection of health management issues crucial to Italy or different from other countries is described (i.e., use of alternatives for infection prophylaxis because of the lack of oral penicillin in Italy). Conclusions Creating a network of physicians involved in the day-to-day care of children with SCD is feasible in a country where it remains rare. Providing hematologists, primary and secondary care physicians, and caregivers across the country with web-based guidelines for the management of SCD tailored to the Italian context is the first step in building a sustainable response to a rare but emerging childhood blood disorder and in implementing the World Health Organization’s suggestion “to design (and) implement … comprehensive national integrated programs for the prevention and management of SCD".
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The use of US health insurance data for surveillance of rare disorders: hereditary hemorrhagic telangiectasia. Genet Med 2013; 16:33-9. [PMID: 23703685 DOI: 10.1038/gim.2013.66] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/16/2013] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess the utility of US health insurance data for surveillance of hereditary hemorrhagic telangiectasia, an autosomal-dominant blood vasculature disorder with an estimated prevalence of 1.5-2.0 per 10,000 persons worldwide. METHODS We used 2005-2010 MarketScan Research Databases to identify individuals with employer-sponsored health insurance and International Classification of Disease, 9th Revision, Clinical Modification codes of 448.0 present in either one inpatient claim or two outpatient claims 30 days apart to define hereditary hemorrhagic telangiectasia. We examined frequencies of International Classification of Disease, 9th Revision, Clinical Modification codes for conditions that are complications of hereditary hemorrhagic telangiectasia among individuals with hereditary hemorrhagic telangiectasia and the general population to identify combinations of codes associated with hereditary hemorrhagic telangiectasia. RESULTS Excluding observations from one state, the average prevalence of hereditary hemorrhagic telangiectasia was 0.3 per 10,000 persons. The reported prevalence rose with age from ~0.1 per 10,000 at ages <30 years to 1.0-1.1 per 10,000 at ages 70 years and above. The condition codes that were most specific to presumed hereditary hemorrhagic telangiectasia were lung arteriovenous malformations and upper gastrointestinal angiodysplasia. Combinations of those codes and codes for brain arteriovenous malformation and epistaxis were highly predictive of reporting of hereditary hemorrhagic telangiectasia, with 20-57% of enrollees with those codes also meeting the study definition for hereditary hemorrhagic telangiectasia. CONCLUSION Hereditary hemorrhagic telangiectasia is underrecognized in US administrative data. Administrative health data can be used to identify individuals with combinations of signs that are suggestive of hereditary hemorrhagic telangiectasia. Studies are needed to test the hypothesis that referral for evaluation of individuals with administrative records suggestive of undiagnosed hereditary hemorrhagic telangiectasia could lead to diagnosis and access to life-saving treatments for both them and affected family members.
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Tarantino MD, Ye X, Bergstrom F, Skorija K, Luo MP. The impact of the economic downturn and health care reform on treatment decisions for haemophilia A: patient, caregiver and health care provider perspectives. Haemophilia 2012; 19:51-8. [DOI: 10.1111/hae.12008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - X. Ye
- Baxter BioScience; Deerfield; IL; USA
| | - F. Bergstrom
- Covance Market Access Services, Gaithersburg; MD; USA
| | - K. Skorija
- Covance Market Access Services, Gaithersburg; MD; USA
| | - M. P. Luo
- Bleeding and Clotting Disorders Institute; Peoria; IL; USA
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Suchdev PS, Ruth LJ, Earley M, Macharia A, Williams TN. The burden and consequences of inherited blood disorders among young children in western Kenya. MATERNAL AND CHILD NUTRITION 2012; 10:135-44. [PMID: 22973867 PMCID: PMC3963444 DOI: 10.1111/j.1740-8709.2012.00454.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Although inherited blood disorders are common among children in many parts of Africa, limited data are available about their prevalence or contribution to childhood anaemia. We conducted a cross‐sectional survey of 858 children aged 6–35 months who were randomly selected from 60 villages in western Kenya. Haemoglobin (Hb), ferritin, malaria, C‐reactive protein (CRP) and retinol binding protein (RBP) were measured from capillary blood. Using polymerase chain reaction (PCR), Hb type, −3.7 kb alpha‐globin chain deletion, glucose‐6‐phosphate dehydrogenase (G6PD) genotype and haptoglobin (Hp) genotype were determined. More than 2 out of 3 children had at least one measured blood disorder. Sickle cell trait (HbAS) and disease (HbSS) were found in 17.1% and 1.6% of children, respectively; 38.5% were heterozygotes and 9.6% were homozygotes for α+‐thalassaemia. The Hp 2‐2 genotype was found in 20.4% of children, whereas 8.2% of males and 6.8% of children overall had G6PD deficiency. There were no significant differences in the distribution of malaria by the measured blood disorders, except among males with G6PD deficiency who had a lower prevalence of clinical malaria than males of normal G6PD genotype (P = 0.005). After excluding children with malaria parasitaemia, inflammation (CRP > 5 mg L−1), iron deficiency (ferritin < 12 μg L−1) or vitamin A deficiency (RBP < 0.7 μg L−1), the prevalence of anaemia among those without α+‐thalassaemia (43.0%) remained significantly lower than that among children who were either heterozygotes (53.5%) or homozygotes (67.7%, P = 0.03). Inherited blood disorders are common among pre‐school children in western Kenya and are important contributors to anaemia.
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Affiliation(s)
- Parminder S Suchdev
- Nutrition Branch, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA; Department of Pediatrics and Global Health, Emory University, Atlanta, Georgia, USA
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Grosse SD, Atrash HK, Odame I, Amendah D, Piel FB, Williams TN. The Jamaican historical experience of the impact of educational interventions on sickle cell disease child mortality. Am J Prev Med 2012; 42:e101-3. [PMID: 22608387 PMCID: PMC4454888 DOI: 10.1016/j.amepre.2012.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 02/15/2012] [Accepted: 03/12/2012] [Indexed: 11/17/2022]
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Grosse SD, James AH, Lloyd-Puryear MA, Atrash HK. A public health framework for rare blood disorders. Am J Prev Med 2011; 41:S319-23. [PMID: 22099353 DOI: 10.1016/j.amepre.2011.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 09/07/2011] [Accepted: 09/07/2011] [Indexed: 10/15/2022]
Affiliation(s)
- Scott D Grosse
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia 30333, USA.
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