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Ebeid FSE, Aly NH, Shaheen NM, Abdellatif SMA, Okba AAM, Gad NA, Makkeyah SM. Safety and efficacy of L-Glutamine in reducing the frequency of acute complications among patients with sickle cell disease: A randomized controlled study. Ann Hematol 2024; 103:3493-3506. [PMID: 39028356 PMCID: PMC11358349 DOI: 10.1007/s00277-024-05877-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 07/03/2024] [Indexed: 07/20/2024]
Abstract
To evaluate the safety and efficacy of L-glutamine in reducing vaso-occlusive crisis (VOC) and improving cerebral arterial blood flow in children with sickle cell disease (SCD). This is an interventional randomized controlled trial that recruited sixty SCD patients, aged 9.2 ± 3.7 years, who had at least two VOCs during the last 12 months and on a stable dose of hydroxyurea. They were randomly assigned in a 1:1 ratio to receive glutamine (0.3 gm/kg/dose/12h) orally for 24 weeks or the standard of care (SOC). All patients had VOCs in the last year > 3, those on glutamine had a higher number of VOCs and hospitalization for VOC in the last year. There was a decreasing trend in the number, severity, and hospitalization of VOC and a significantly lower cumulative number of VOCs and hospitalizations in the glutamine group than in SOC (p = 0.008, p < 0.001 respectively). Time-averaged mean maximum velocity for the glutamine group had a marginal increase in both middle cerebral arteries, all values remained normal within a normal range, and in both internal carotid arteries, values increased from abnormally low to normal ranges at week 24. Glutamine reduced the number of VOCs and severity and may have a potentially favorable impact on the cerebral arterial flow velocities.
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Affiliation(s)
- Fatma Soliman Elsayed Ebeid
- Pediatric Hematology Oncology and BMT Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
- Faculty of Medicine, Ain Shams University Research Institute-Clinical Research Center (MASRI-CRC), Cairo, Egypt.
| | - Nihal Hussien Aly
- Pediatric Hematology Oncology and BMT Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | | | - Nada Ayman Gad
- Pediatric Department, Egyptian Atomic Energy Authority, National Centre for Radiation Research and Technology, Cairo, Egypt
| | - Sara Mostafa Makkeyah
- Pediatric Hematology Oncology and BMT Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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2
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Cruz N, Valente T, Ferreira F, Macedo L, Belisário A, da Silva C, Oliveira N, Gomides A, Velloso-Rodrigues C. CETP gene polymorphisms and haplotypes are explanatory variables for HDL cholesterol level in sickle cell disease. Braz J Med Biol Res 2024; 57:e12879. [PMID: 38265339 PMCID: PMC10802225 DOI: 10.1590/1414-431x2023e12879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/18/2023] [Indexed: 01/25/2024] Open
Abstract
Variations in lipid profile have been observed in sickle cell disease (SCD) and understanding their relationship with disease severity is crucial. This study aimed to investigate the association of polymorphisms of the CETP gene and laboratory markers of disease severity with lipid profile in a pediatric population with SCD. Biochemical and anthropometric analyses and CETP and alpha-thalassemia genotyping were performed. The study included 133 children and adolescents with sickle cell anemia (SCA) or hemoglobin SC disease (SCC), in steady-state. The SCA and no hydroxyurea (no HU) groups had higher values of ApoB, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C) compared to the SCC and HU groups. However, there were no significant differences in ApoA1 and HDL-C levels between the groups based on genotype. Furthermore, the groups with altered levels of ApoA1, HDL-C, and the triglyceride/HDL ratio exhibited lower hemoglobin (Hb) levels and higher white blood cell counts. Hb level was associated to HDL-C levels. Analysis of CETP gene variants showed that the minor alleles of rs3764261 (C>A), rs247616 (C>T), and rs183130 (C>T), as well as the TTA haplotype, are explanatory variables for HDL-C levels. These findings suggested that dyslipidemia in SCD, specifically related to HDL-C levels, may be influenced by individual genetic background. Additionally, further investigation is needed to determine if clinical manifestations are impacted by CETP gene variants.
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Affiliation(s)
- N.R.C. Cruz
- Laboratório de Biologia Celular e Genética Molecular, Departamento de Nutrição, Universidade Federal de Juiz de Fora - Campus Governador Valadares, Governador Valadares, MG, Brasil
| | - T.N.S. Valente
- Laboratório de Biologia Celular e Genética Molecular, Departamento de Ciências Básicas da Vida, Universidade Federal de Juiz de Fora - Campus Governador Valadares, Governador Valadares, MG, Brasil
| | - F.O. Ferreira
- Departamento de Ciências Básicas da Vida, Universidade Federal de Juiz de Fora - Campus Governador Valadares, Governador Valadares, MG, Brasil
| | - L.R. Macedo
- Departamento de Economia, Universidade Federal de Juiz de Fora - Campus Governador Valadares, Governador Valadares, MG, Brasil
| | - A.R. Belisário
- Centro de Tecidos Biológicos, Fundação Hemominas, Lagoa Santa, MG, Brasil
| | - C.M. da Silva
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brasil
| | - N.S. Oliveira
- Laboratório de Biologia Celular e Genética Molecular, Departamento de Nutrição, Universidade Federal de Juiz de Fora - Campus Governador Valadares, Governador Valadares, MG, Brasil
| | - A.F.F. Gomides
- Laboratório de Biologia Celular e Genética Molecular, Departamento de Ciências Básicas da Vida, Universidade Federal de Juiz de Fora - Campus Governador Valadares, Governador Valadares, MG, Brasil
| | - C. Velloso-Rodrigues
- Laboratório de Biologia Celular e Genética Molecular, Departamento de Ciências Básicas da Vida, Universidade Federal de Juiz de Fora - Campus Governador Valadares, Governador Valadares, MG, Brasil
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3
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Ginete C, Delgadinho M, Santos B, Pinto V, Silva C, Miranda A, Brito M. Are Genetic Modifiers the Answer to Different Responses to Hydroxyurea Treatment?-A Pharmacogenetic Study in Sickle Cell Anemia Angolan Children. Int J Mol Sci 2023; 24:ijms24108792. [PMID: 37240136 DOI: 10.3390/ijms24108792] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Sickle cell anemia (SCA) is an inherited disease affecting the hemoglobin that is particularly common in sub-Saharan Africa. Although monogenic, phenotypes are markedly heterogeneous in terms of severity and life span. Hydroxyurea is still the most common treatment for these patients, and the response to treatment is highly variable and seems to be an inherited trait. Therefore, identifying the variants that might predict hydroxyurea response is important for identifying patients who will have a poorer or non-response to treatment, and the ones that are more prone to suffer from severe side effects. In the present pharmacogenetic study, we analyzed the exons of 77 genes described in the literature as potentially associated with hydroxyurea metabolism in Angolan children treated with hydroxyurea and evaluated the drug response considering fetal hemoglobin levels, other hematological and biochemical parameters, hemolysis, number of vaso-occlusive crises and hospitalizations. Thirty variants were identified in 18 of those genes as possibly associated with drug response, five of them in gene DCHS2. Other polymorphisms in this gene were also associated with hematological, biochemical and clinical parameters. Further research examining the maximum tolerated dose and fixed dose with a larger sample size is necessary to corroborate these findings.
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Affiliation(s)
- Catarina Ginete
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal
| | - Mariana Delgadinho
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal
| | - Brígida Santos
- Centro de Investigação em Saúde de Angola (CISA), Bengo, Angola
- Hospital Pediátrico David Bernardino (HPDB), Luanda, Angola
| | - Vera Pinto
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal
- Centro de Estatística e Aplicações, Universidade de Lisboa (CEAUL), 1749-016 Lisbon, Portugal
| | - Carina Silva
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal
- Centro de Estatística e Aplicações, Universidade de Lisboa (CEAUL), 1749-016 Lisbon, Portugal
| | - Armandina Miranda
- Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), 1649-016 Lisbon, Portugal
| | - Miguel Brito
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal
- Centro de Investigação em Saúde de Angola (CISA), Bengo, Angola
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4
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Alakbarzade V, Maduakor C, Khan U, Khandanpour N, Rhodes E, Pereira AC. Cerebrovascular disease in sickle cell disease. Pract Neurol 2023; 23:131-138. [PMID: 36123118 DOI: 10.1136/pn-2022-003440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/04/2022]
Abstract
Sickle cell disease (SCD) is the most common type of hereditary anaemia and genetic disorder worldwide. Cerebrovascular disease is one of its most devastating complications, with consequent increased morbidity and mortality. Current guidelines suggest that children and adults with SCD who develop acute ischaemic stroke should be transfused without delay. Those with acute ischaemic stroke aged over 18 years who present within 4.5 hours of symptom onset should be considered for intravenous thrombolysis; older patients with conventional vascular risk factors are the most likely to benefit. Endovascular thrombectomy should be considered carefully in adults with SCD as there are few data to guide how the prevalence of cerebral vasculopathy may confound the expected benefits or risks of intervention. We present a practical approach to cerebrovascular disease in sickle cell patients based on the available evidence and our experience.
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Affiliation(s)
- Vafa Alakbarzade
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Chinedu Maduakor
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Usman Khan
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Nader Khandanpour
- Department of Neuroradiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Elizabeth Rhodes
- Department of Haematology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Anthony C Pereira
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
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5
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Pinto VM, Gianesin B, Piel FB, Longo F, Rigano P, Quota A, Spadola V, Graziadei G, Mazzi F, Cappellini MD, Maggio A, Piga A, De Franceschi L, Forni GL. Morbidity and mortality of sickle cell disease patients is unaffected by splenectomy: evidence from three decades of follow-up in a high-income setting. Haematologica 2023; 108:1158-1162. [PMID: 35924578 PMCID: PMC10071109 DOI: 10.3324/haematol.2022.280815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/15/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Valeria Maria Pinto
- Center for Microcythemia, Congenital Anemia and Iron Dysmetabolism, Galliera Hospital, Genoa
| | | | - Frédéric B Piel
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London
| | - Filomena Longo
- Reference Centre for Hemoglobinopathies, AOU San Luigi Gonzaga Hospital, Orbassano
| | - Paolo Rigano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo
| | - Alessandra Quota
- Thalassemia Unit, P.O. Vittorio Emanuele III, Gela, Caltanissetta Italy
| | | | - Giovanna Graziadei
- Department of Medicine and Medical Specialities, IRCCS Ca' Granda Foundation, Maggiore Policlinico Hospital, Milan
| | - Filippo Mazzi
- Department of Medicine, University of Verona and AOUI Verona, Policlinico GB Rossi, Verona
| | - Maria Domenica Cappellini
- Department of Medicine and Medical Specialities, IRCCS Ca' Granda Foundation, Maggiore Policlinico Hospital, Milan
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo
| | - Antonio Piga
- Department of Clinical and Biological Sciences, University of Turin
| | - Lucia De Franceschi
- Department of Medicine, University of Verona and AOUI Verona, Policlinico GB Rossi, Verona
| | - Gian Luca Forni
- Center for Microcythemia, Congenital Anemia and Iron Dysmetabolism, Galliera Hospital, Genoa.
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6
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Alabed HBR, Gorello P, Pellegrino RM, Lancioni H, La Starza R, Taddei AA, Urbanelli L, Buratta S, Fernandez AGL, Matteucci C, Caniglia M, Arcioni F, Mecucci C, Emiliani C. Comparison between Sickle Cell Disease Patients and Healthy Donors: Untargeted Lipidomic Study of Erythrocytes. Int J Mol Sci 2023; 24:ijms24032529. [PMID: 36768849 PMCID: PMC9917006 DOI: 10.3390/ijms24032529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Sickle cell disease (SCD) is one of the most common severe monogenic disorders in the world caused by a mutation on HBB gene and characterized by hemoglobin polymerization, erythrocyte rigidity, vaso-occlusion, chronic anemia, hemolysis, and vasculopathy. Recently, the scientific community has focused on the multiple genetic and clinical profiles of SCD. However, the lipid composition of sickle cells has received little attention in the literature. According to recent studies, changes in the lipid profile are strongly linked to several disorders. Therefore, the aim of this study is to dig deeper into lipidomic analysis of erythrocytes in order to highlight any variations between healthy and patient subjects. 241 lipid molecular species divided into 17 classes have been annotated and quantified. Lipidomic profiling of SCD patients showed that over 24% of total lipids were altered most of which are phospholipids. In-depth study of significant changes in lipid metabolism can give an indication of the enzymes and genes involved. In a systems biology scenario, these variations can be useful to improve the understanding of the biochemical basis of SCD and to try to make a score system that could be predictive for the severity of clinical manifestations.
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Affiliation(s)
- Husam B. R. Alabed
- Department of Chemistry, Biology and Biotechnology, University of Perugia, 06100 Perugia, Italy
| | - Paolo Gorello
- Department of Chemistry, Biology and Biotechnology, University of Perugia, 06100 Perugia, Italy
| | - Roberto Maria Pellegrino
- Department of Chemistry, Biology and Biotechnology, University of Perugia, 06100 Perugia, Italy
- Correspondence:
| | - Hovirag Lancioni
- Department of Chemistry, Biology and Biotechnology, University of Perugia, 06100 Perugia, Italy
| | - Roberta La Starza
- Hematology and Bone Marrow Transplantation Unit, Laboratory of Molecular Medicine (CREO), Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Anna Aurora Taddei
- Department of Chemistry, Biology and Biotechnology, University of Perugia, 06100 Perugia, Italy
| | - Lorena Urbanelli
- Department of Chemistry, Biology and Biotechnology, University of Perugia, 06100 Perugia, Italy
| | - Sandra Buratta
- Department of Chemistry, Biology and Biotechnology, University of Perugia, 06100 Perugia, Italy
| | - Anair Graciela Lema Fernandez
- Hematology and Bone Marrow Transplantation Unit, Laboratory of Molecular Medicine (CREO), Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Caterina Matteucci
- Hematology and Bone Marrow Transplantation Unit, Laboratory of Molecular Medicine (CREO), Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Maurizio Caniglia
- Pediatric Oncology-Hematology, Azienda Ospedaliera di Perugia, 06100 Perugia, Italy
| | - Francesco Arcioni
- Pediatric Oncology-Hematology, Azienda Ospedaliera di Perugia, 06100 Perugia, Italy
| | - Cristina Mecucci
- Hematology and Bone Marrow Transplantation Unit, Laboratory of Molecular Medicine (CREO), Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Carla Emiliani
- Department of Chemistry, Biology and Biotechnology, University of Perugia, 06100 Perugia, Italy
- Centro di Eccellenza sui Materiali Innovativi Nanostrutturati (CEMIN), University of Perugia, Via del Giochetto, 06123 Perugia, Italy
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7
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Real-World Evidence on Disease Burden and Economic Impact of Sickle Cell Disease in Italy. J Clin Med 2022; 12:jcm12010117. [PMID: 36614918 PMCID: PMC9821386 DOI: 10.3390/jcm12010117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/05/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
A real-world analysis was conducted in Italy among sickle cell disease (SCD) patients to evaluate the epidemiology of SCD, describe patients' characteristics and the therapeutic and economic burden. A retrospective analysis of administrative databases of various Italian entities was carried out. All patients with ≥1 hospitalization with SCD diagnosis were included from 01/2010-12/2017 (up to 12/2018 for epidemiologic analysis). The index date corresponded to the first SCD diagnosis. In 2018, SCD incidence rate was 0.93/100,000, the prevalence was estimated at 13.1/100,000. Overall, 1816 patients were included. During the 1st year of follow-up, 50.7% of patients had one all-cause hospitalization, 27.8% had 2, 10.4% had 3, and 11.1% had ≥4. Over follow-up, 6.1-7.2% of patients were treated with SCD-specific, 58.4-69.4% with SCD-related, 60.7-71.3% with SCD-complications-related drugs. Mean annual number per patient of overall treatments was 14.9 ± 13.9, hospitalizations 1.1 ± 1.1, and out-patient services 5.3 ± 7.6. The total mean direct cost per patient was EUR 7918/year (EUR 2201 drugs, EUR 3320 hospitalizations, and EUR 2397 out-patient services). The results from this real-world analysis showed a high disease burden for SCD patients with multiple hospitalizations during the follow-up. High healthcare resource utilization and costs were associated with patient' management and were most likely underestimated since indirect costs and Emergency Room admissions were not included.
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8
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Bernaudin F, Arnaud C, Kamdem A, Hau I, Madhi F, Jung C, Epaud R, Verlhac S. Incidence, kinetics, and risk factors for intra- and extracranial cerebral arteriopathies in a newborn sickle cell disease cohort early assessed by transcranial and cervical color Doppler ultrasound. Front Neurol 2022; 13:846596. [PMID: 36188389 PMCID: PMC9515365 DOI: 10.3389/fneur.2022.846596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
The risk of stroke in children with sickle cell disease (SCD) is detected by abnormal intracranial arterial time-averaged mean of maximum velocities (TAMVs ≥200 cm/s). Recently, extracranial internal carotid artery (eICA) arteriopathy has been reported, and a cross-sectional study showed that eICA-TAMVs ≥160 cm/s are significantly associated with eICA kinkings and stenosis. The cumulative incidence of and predictive risk factors for intracranial arteriopathy are well described in sickle cell anemia (SCA=SS/Sβ0) but are lacking for SC/Sβ+ children, as is the cumulative incidence of eICA arteriopathy. We report a prospective longitudinal cohort study including 493 children with SCD (398 SCA, 95 SC/Sβ+), all assessed by transcranial and cervical color Doppler ultrasound. Cerebral MRI/MRA data were available in 375 children with SCD and neck MRA in 365 children. eICA kinkings were defined as eICA tortuosities on neck MRA, with an internal acute angle between the two adjacent segments <90°. The median follow-up was 10.6 years. The cumulative incidence of kinkings was significantly lower in SC/Sβ+ children than in children with SCA, and no SC/Sβ+ child developed intra- or extracranial stenotic arteriopathy. The 10-year KM estimate of cumulative incidence (95% CI) for eICA-TAMVs ≥160 cm/s revealed its development in the 2nd year of life in children with SCA, reaching a plateau of 17.4% (13.2–21.6%) by about 10 years of age, while the plateau for eICA stenosis was 12.3% (8.3–16.3%). eICA assessment identified 13.5% (9.3–17.7%) patients at risk of stroke who were not detected by transcranial color Doppler ultrasound. We also show, for the first time, that in addition to a congenital origin, eICA kinkings sin patients with SCD can develop progressively with aging as a function of eICA-TAMVs, themselves related to anemia severity. Ongoing hydroxyurea treatment was significantly associated with a lower risk of abnormal intracranial arteriopathy and eICA kinkings. After adjustment with hydroxyurea, baseline low hemoglobin, high reticulocyte, and WBC counts remained independent risk factors for intracranial arteriopathy, while low hemoglobin and SEN β-haplotype number were independent risk factors for extracranial arteriopathy. The association between extracranial arteriopathy and SEN β-haplotype number suggested a genetic link between the ethnic origin and incidence of eICA kinkings. This prospective cohort study shows the importance of systematically assessing the eICA and of recording biological parameters during the 2nd year of life before any intensive therapy to predict the risk of cerebral arteriopathy and treat patients with severe baseline anemia.
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Affiliation(s)
- Françoise Bernaudin
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Intercommunal Créteil Hospital, University Paris Est, Créteil, France
- Clinical Research Center, Intercommunal Créteil Hospital, University Paris Est, Créteil, France
- *Correspondence: Françoise Bernaudin
| | - Cécile Arnaud
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Intercommunal Créteil Hospital, University Paris Est, Créteil, France
| | - Annie Kamdem
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Intercommunal Créteil Hospital, University Paris Est, Créteil, France
| | - Isabelle Hau
- Department of Pediatrics, Intercommunal Créteil Hospital, University Paris Est, Créteil, France
| | - Fouad Madhi
- Department of Pediatrics, Intercommunal Créteil Hospital, University Paris Est, Créteil, France
| | - Camille Jung
- Clinical Research Center, Intercommunal Créteil Hospital, University Paris Est, Créteil, France
| | - Ralph Epaud
- Department of Pediatrics, Intercommunal Créteil Hospital, University Paris Est, Créteil, France
| | - Suzanne Verlhac
- Department of Medical Imaging, Referral Center for Sickle Cell Disease, Intercommunal Créteil Hospital, Créteil, France
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9
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Treadwell MJ, Du L, Bhasin N, Marsh AM, Wun T, Bender MA, Wong TE, Crook N, Chung JH, Norman S, Camilo N, Cavazos J, Nugent D. Barriers to hydroxyurea use from the perspectives of providers, individuals with sickle cell disease, and families: Report from a U.S. regional collaborative. Front Genet 2022; 13:921432. [PMID: 36092883 PMCID: PMC9461276 DOI: 10.3389/fgene.2022.921432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited blood disorder that affects about 100,000 people in the U.S., primarily Blacks/African-Americans. A multitude of complications negatively impacts quality of life. Hydroxyurea has been FDA approved since 1998 as a disease-modifying therapy for SCD, but is underutilized. Negative and uninformed perceptions of hydroxyurea and barriers to its use hinder adherence and promotion of the medication. As the largest real-world study to date that assessed hydroxyurea use for children and adults with SCD, we gathered and analyzed perspectives of providers, individuals with SCD, and families. Participants provided information about socio-demographics, hospital and emergency admissions for pain, number of severe pain episodes interfering with daily activities, medication adherence, and barriers to hydroxyurea. Providers reported on indications for hydroxyurea, reasons not prescribed, and current laboratory values. We found that hydroxyurea use was reported in over half of eligible patients from this large geographic region in the U.S., representing a range of sickle cell specialty clinical settings and practices. Provider and patient/caregiver reports about hydroxyurea use were consistent with one another; adults 26 years and older were least likely to be on hydroxyurea; and the likelihood of being on hydroxyurea decreased with one or more barriers. Using the intentional and unintentional medication nonadherence framework, we found that, even for patients on hydroxyurea, challenges to taking the medicine at the right time and forgetting were crucial unintentional barriers to adherence. Intentional barriers such as worry about side effects and “tried and it did not work” were important barriers for young adults and adults. For providers, diagnoses other than HgbSS or HgbS-β0 thalassemia were associated with lower odds of prescribing, consistent with evidence-based guidelines. Our results support strengthening provider understanding and confidence in implementing existing SCD guidelines, and the importance of shared decision making. Our findings can assist providers in understanding choices and decisions of families; guide individualized clinical discussions regarding hydroxyurea therapy; and help with developing tailored interventions to address barriers. Addressing barriers to hydroxyurea use can inform strategies to minimize similar barriers in the use of emerging and combination therapies for SCD.
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Affiliation(s)
- Marsha J. Treadwell
- Division of Hematology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States
- *Correspondence: Marsha J. Treadwell,
| | - Lisa Du
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States
| | - Neha Bhasin
- Division of Hematology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States
| | - Anne M. Marsh
- Division of Hematology/Oncology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Theodore Wun
- Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis, Davis, CA, United States
| | - M. A. Bender
- Odessa Brown Children’s Clinic, Seattle Children’s Hospital, Seattle, WA, United States
| | - Trisha E. Wong
- Division of Pediatric Hematology and Oncology and Department of Pathology, Oregon Health and Sciences University, Portland, OR, United States
| | - Nicole Crook
- Center for Inherited Blood Disorders, Orange, CA, United States
| | - Jong H. Chung
- Hematology-Oncology, Department of Pediatrics, University of California, Davis, Davis, CA, United States
| | - Shannon Norman
- Alaska Bleeding Disorders Clinic, Anchorage, AK, United States
| | - Nicolas Camilo
- St. Luke’s Children’s Cancer Institute, Boise, ID, United States
| | - Judith Cavazos
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States
| | - Diane Nugent
- Center for Inherited Blood Disorders, Orange, CA, United States
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10
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Phan V, Park JA, Dulman R, Lewis A, Briere N, Notarangelo B, Yang E. Ten-year Longitudinal Analysis of Hydroxyurea Implementation in a Pediatric Sickle Cell Program. Eur J Haematol 2022; 109:465-473. [PMID: 35811388 DOI: 10.1111/ejh.13827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/27/2022]
Abstract
Hydroxyurea (HU) has proven benefit in sickle cell anemia (SCA), but HU is still underutilized. The Pediatric Sickle Cell Program of Northern Virginia prescribes HU regardless of symptoms to all SCA patients age ≥ 9 months and prospectively tracks outcomes. HU is dosed to maximum tolerated dosing (MTD), targeting 30% Hgb F. Longitudinal data from 2009-2019 encompassing 1222 HU-eligible and 950 HU-exposure patient-years were analyzed in 2-year intervals for hemoglobin (Hgb), fetal hemoglobin (Hgb F), hospitalizations, transfusions, and treat-and-release ED visits. Comparing HU-eligible patients in the interval prior to HU implementation (2009-2011) to the last interval analyzed after HU implementation (2017-2019), HU usage increased from 33% to 93%, average Hgb increased from 8.3±0.98 to 9.8±1.3 g/dL (p<0.0001), average Hgb F rose from 13±8.7% to 26±9.9% (p<0.0001), hospitalizations decreased from 0.71 (95% CI 0.54-0.91) to 0.2 (95% CI 0.13-0.28) admissions/person-year, sporadic transfusions decreased from 0.4 (95% CI 0.27-0.55) to 0.05 (95% CI 0.02-0.12) transfusions/person-year. Treat-and-release ED visit rates remained unchanged, varying between 0.49 (95% CI 0.36-0.64) and 0.64 (95% CI 0.48-0.83) visits/person-year. By the last interval, 72% of patients had Hgb ≥ 9g/dL, 42% had Hgb F ≥ 30%, 79% experienced no hospitalizations, and 94% received no transfusions. Uniform HU prescription for SCA patients with close monitoring to achieve high Hgb F resulted in significant improvements in laboratory and clinical outcomes within 2 years, which continued to improve over the next 6 years. Rigorous HU implementation in a pediatric sickle cell population is feasible, effective, and sustainable. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Vivian Phan
- Pediatric Specialists of Virginia, Fairfax, VA
| | - Ju Ae Park
- Inova Fairfax Hospital, Falls Church, VA
| | | | | | | | | | - Elizabeth Yang
- Pediatric Specialists of Virginia, Fairfax, VA.,Department of Pediatrics, George Washington University School of Medicine, Washington, DC
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11
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Graziadei G, De Franceschi L, Sainati L, Venturelli D, Masera N, Bonomo P, Vassanelli A, Casale M, Lodi G, Voi V, Rigano P, Pinto VM, Quota A, Notarangelo LD, Russo G, Allò M, Rosso R, D'Ascola D, Facchini E, Macchi S, Arcioni F, Bonetti F, Rossi E, Sau A, Campisi S, Colarusso G, Giona F, Lisi R, Giordano P, Boscarol G, Filosa A, Marktel S, Maroni P, Murgia M, Origa R, Longo F, Bortolotti M, Colombatti R, Di Maggio R, Mariani R, Piperno A, Corti P, Fidone C, Palazzi G, Badalamenti L, Gianesin B, Piel FB, Forni GL. Transfusional Approach in Multi-Ethnic Sickle Cell Patients: Real-World Practice Data From a Multicenter Survey in Italy. Front Med (Lausanne) 2022; 9:832154. [PMID: 35372393 PMCID: PMC8967327 DOI: 10.3389/fmed.2022.832154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Abstract
Sickle cell disease (SCD) is a worldwide distributed hereditary red cell disorder characterized by recurrent acute vaso-occlusive crises (VOCs and anemia). Gold standard treatments are hydroxycarbamide (HC) and/or different red blood cell (RBC) transfusion regimens to limit disease progression. Here, we report a retrospective study on 1,579 SCD patients (median age 23 years; 802 males/777 females), referring to 34 comprehensive Italian centers for hemoglobinopathies. Although we observed a similar proportion of Caucasian (47.9%) and African (48.7%) patients, Italian SCD patients clustered into two distinct overall groups: children of African descent and adults of Caucasian descent. We found a subset of SCD patients requiring more intensive therapy with a combination of HC plus chronic transfusion regimen, due to partial failure of HC treatment alone in preventing or reducing sickle cell-related acute manifestations. Notably, we observed a higher use of acute transfusion approaches for SCD patients of African descent when compared to Caucasian subjects. This might be related to (i) age of starting HC treatment; (ii) patients' low social status; (iii) patients' limited access to family practitioners; or (iv) discrimination. In our cohort, alloimmunization was documented in 135 patients (8.5%) and was more common in Caucasians (10.3%) than in Africans (6.6%). Alloimmunization was similar in male and female and more frequent in adults than in children. Our study reinforces the importance of donor-recipient exact matching for ABO, Rhesus, and Kell antigen systems for RBC compatibility as a winning strategy to avoid or limit alloimmunization events that negatively impact the clinical management of SCD-related severe complications.
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Affiliation(s)
- Giovanna Graziadei
- Rare Diseases Center, General Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Laura Sainati
- Dipartimento della Salute della Donna e del Bambino Azienda Ospedaliera, Azienda Ospedaliera Universitaria, Padova, Italy
| | - Donatella Venturelli
- Servizio Immunotrasfusionale, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - Nicoletta Masera
- Pediatric Clinic Hemato-Oncology Department, University of Milano-Bicocca, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Piero Bonomo
- Servizio Immunotrasfusionale, Azienda Ospedaliera Maria Paternò Arezzo, Ragusa, Italy
| | - Aurora Vassanelli
- UOC Medicina Trasfusionale, Azienda Ospedaliera Universitaria, Verona, Italy
| | - Maddalena Casale
- Department of Women, Child and General and Specialized Surgery, University “Luigi Vanvitelli”, Naples, Italy
| | - Gianluca Lodi
- Medicina Trasfusionale, Azienda Ospedaliera Universitaria Sant'Anna, Ferrara, Italy
| | - Vincenzo Voi
- Centro per le Emoglobinopatie – Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Ospedale San Luigi Gonzaga, Torino, Italy
| | - Paolo Rigano
- Campus of Haematology Franco e Piera Cutino, A.O.O.R. “Villa Sofia-Cervello” di Palermo, Palermo, Italy
| | - Valeria Maria Pinto
- Hematology, Thalassemia and Congenital Anemia Center, Ospedale Galliera, Genova, Italy
| | - Alessandra Quota
- Unità Operativa Semplice Dipartimentale Talassemia P.O. Vittorio Emanuele, Gela, Italy
| | - Lucia D. Notarangelo
- Italian Association of Pediatric Hematology Oncology (AIEOP) Coagulation Disorders Working Group, Brescia, Italy
| | - Giovanna Russo
- Pediatric Hematology/Oncology Unit, Università di Catania, Catania, Italy
| | - Massimo Allò
- Servizio Microcitemia, Presidio Ospedaliero SL 5, Crotone, Italy
| | - Rosamaria Rosso
- UOSD di Talassemia ed Emoglobinopatie, Azienda Ospedaliero-Universitaria Policlinico San Marco, Catania, Italy
| | - Domenico D'Ascola
- Centro Microcitemie, Azienda Ospedaliera “Bianchi-Melacrino-Morelli”, Reggio Calabria, Italy
| | - Elena Facchini
- SSD Oncoematologia Pediatrica - Policlinico di S.Orsola, Bologna, Italy
| | - Silvia Macchi
- Servizio Trasfusionale, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | | | | | - Enza Rossi
- Unità Operativa Ematologia, Centro di Microcitemia, Azienda Ospedaliera di Cosenza, Presidio Ospedaliero “Annunziata” Cosenza, Cosenza, Italy
| | | | - Saveria Campisi
- Department of Talassemia, Siracusa Hospital, Siracusa, Italy
| | | | - Fiorina Giona
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Roberto Lisi
- Unità Operativa Dipartimentale Talassemia, Presidio Garibaldi-Centro ARNAS Garibaldi, Catania, Italy
| | - Paola Giordano
- UOC Pediatria Universitaria, Università di Bari, Bari, Italy
| | | | - Aldo Filosa
- UOSD Malattie rare del globulo rosso, AORN A. Cardarelli, Naples, Italy
| | - Sarah Marktel
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Maroni
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Sette Laghi, Varese, Italy
| | - Mauro Murgia
- Centro Provinciale per le Microcitemia, Ospedale San Martino di Oristano, Oristano, Italy
| | - Raffaella Origa
- Ospedale Pediatrico Microcitemico, Università di Cagliari, Cagliari, Italy
| | - Filomena Longo
- Hematology, Thalassemia and Congenital Anemia Center, Ospedale Galliera, Genova, Italy
| | - Marta Bortolotti
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy
| | - Raffaella Colombatti
- Dipartimento della Salute della Donna e del Bambino Azienda Ospedaliera, Azienda Ospedaliera Universitaria, Padova, Italy
| | - Rosario Di Maggio
- Unità Operativa Semplice Dipartimentale Talassemia P.O. Vittorio Emanuele, Gela, Italy
| | - Raffaella Mariani
- Rare Disease Centre - Hereditary anemias - ASST-Monza, S. Gerardo Hospital - University of Milano-Bicocca, Monza, Italy
| | - Alberto Piperno
- Rare Disease Centre - Hereditary anemias - ASST-Monza, S. Gerardo Hospital - University of Milano-Bicocca, Monza, Italy
| | - Paola Corti
- Pediatric Clinic Hemato-Oncology Department, University of Milano-Bicocca, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Carmelo Fidone
- Servizio Immunotrasfusionale, Azienda Ospedaliera Maria Paternò Arezzo, Ragusa, Italy
| | - Giovanni Palazzi
- Servizio Immunotrasfusionale, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - Luca Badalamenti
- Biomedicina, Neuroscienze e Diagnostica avanzata, University of Palermo, Palermo, Italy
| | | | - Frédéric B. Piel
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Gian Luca Forni
- Italian Association of Pediatric Hematology Oncology (AIEOP) Coagulation Disorders Working Group, Brescia, Italy
- *Correspondence: Gian Luca Forni
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12
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Sales RR, Nogueira BL, Tosatti JAG, Gomes KB, Luizon MR. Do Genetic Polymorphisms Affect Fetal Hemoglobin (HbF) Levels in Patients With Sickle Cell Anemia Treated With Hydroxyurea? A Systematic Review and Pathway Analysis. Front Pharmacol 2022; 12:779497. [PMID: 35126118 PMCID: PMC8814522 DOI: 10.3389/fphar.2021.779497] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/31/2021] [Indexed: 01/23/2023] Open
Abstract
Hydroxyurea has long been used for the treatment of sickle cell anemia (SCA), and its clinical effectiveness is related to the induction of fetal hemoglobin (HbF), a major modifier of SCA phenotypes. However, there is substantial variability in response to hydroxyurea among patients with SCA. While some patients show an increase in HbF levels and an ameliorated clinical condition under low doses of hydroxyurea, other patients present a poor effect or even develop toxicity. However, the effects of genetic polymorphisms on increasing HbF levels in response to hydroxyurea in patients with SCA (Hb SS) have been less explored. Therefore, we performed a systematic review to assess whether single-nucleotide polymorphisms (SNPs) affect HbF levels in patients with SCA treated with hydroxyurea. Moreover, we performed pathway analysis using the set of genes with SNPs found to be associated with changes in HbF levels in response to hydroxyurea among the included studies. The systematic literature search was conducted on Medline/PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science. Seven cohort studies were included following our inclusion and exclusion criteria. From the 728 genetic polymorphisms examined in the included studies, 50 different SNPs of 17 genes were found to be associated with HbF changes in patients with SCA treated with hydroxyurea, which are known to affect baseline HbF but are not restricted to them. Enrichment analysis of this gene set revealed reactome pathways with the lowest adjusted p-values and highest combined scores related to VEGF ligand–receptor interactions (R-HSA-194313; R-HSA-195399) and the urea cycle (R-HSA-70635). Pharmacogenetic studies of response to hydroxyurea therapy in patients with SCA are still scarce and markedly heterogeneous regarding candidate genes and SNPs examined for association with HbF changes and outcomes, suggesting that further studies are needed. The reviewed findings highlighted that similar to baseline HbF, changes in HbF levels upon hydroxyurea therapy are likely to be regulated by multiple loci. There is evidence that SNPs in intron 2 of BCL11A affect HbF changes in response to hydroxyurea therapy, a potential application that might improve the clinical management of SCA. Systematic Review Registration: (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=208790).
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Affiliation(s)
- Rahyssa Rodrigues Sales
- Graduate Program in Genetics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
- *Correspondence: Rahyssa Rodrigues Sales, ; Marcelo Rizzatti Luizon,
| | - Bárbara Lisboa Nogueira
- Graduate Program in Genetics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jéssica Abdo Gonçalves Tosatti
- Department of Clinical and Toxicological Analyzes, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Karina Braga Gomes
- Department of Clinical and Toxicological Analyzes, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marcelo Rizzatti Luizon
- Graduate Program in Genetics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Genetics, Ecology and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
- *Correspondence: Rahyssa Rodrigues Sales, ; Marcelo Rizzatti Luizon,
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13
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Economic evaluation of regular transfusions for cerebral infarct recurrence in the Silent Cerebral Infarct Transfusion Trial. Blood Adv 2021; 5:5032-5040. [PMID: 34607344 PMCID: PMC9153054 DOI: 10.1182/bloodadvances.2021004864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/18/2021] [Indexed: 12/03/2022] Open
Abstract
Children with preexisting silent cerebral infarcts on regular transfusion therapy had 50% lower hospitalization costs than standard care. The incremental cost-effectiveness ratio for transfusion therapy to prevent infarct recurrence was $22 025 for every infarct prevented.
In 2020, the American Society of Hematology published evidence-based guidelines for cerebrovascular disease in individuals with sickle cell anemia (SCA). Although the guidelines were based on National Institutes of Health–sponsored randomized controlled trials, no cost-effectiveness analysis was completed for children with SCA and silent cerebral infarcts. We conducted a cost-effectiveness analysis comparing regular blood transfusion vs standard care using SIT (Silent Cerebral Infarct Transfusion) Trial participants. This analysis included a modified societal perspective with direct costs (hospitalization, emergency department visit, transfusion, outpatient care, and iron chelation) and indirect costs (special education). Direct medical costs were estimated from hospitalizations from SIT hospitals and unlinked aggregated hospital and outpatient costs from SIT sites by using the Pediatric Health Information System. Indirect costs were estimated from published literature. Effectiveness was prevention of infarct recurrence. An incremental cost-effectiveness ratio using a 3-year time horizon (mean SIT Trial participant follow-up) compared transfusion vs standard care. A total of 196 participants received transfusions (n = 90) or standard care (n = 106), with a mean age of 10.0 years. Annual hospitalization costs were reduced by 54% for transfusions vs standard care ($4929 vs $10 802), but transfusion group outpatient costs added $22 454 to $137 022 per year. Special education cost savings were $2634 over 3 years for every infarct prevented. Transfusion therapy had an incremental cost-effectiveness ratio of $22 025 per infarct prevented. Children with preexisting silent cerebral infarcts receiving blood transfusions had lower hospitalization costs but higher outpatient costs, primarily associated with the oral iron chelator deferasirox. Regular blood transfusion therapy is cost-effective for infarct recurrence in children with SCA. This trial is registered at www.clinicaltrials.gov as #NCT00072761.
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14
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Montalembert M, Voskaridou E, Oevermann L, Cannas G, Habibi A, Loko G, Joseph L, Colombatti R, Bartolucci P, Brousse V, Galactéros F. Real-Life experience with hydroxyurea in patients with sickle cell disease: Results from the prospective ESCORT-HU cohort study. Am J Hematol 2021; 96:1223-1231. [PMID: 34224583 DOI: 10.1002/ajh.26286] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/28/2022]
Abstract
Several controlled studies have evidenced good efficacy and short-term and mid-term safety profiles for hydroxyurea (HU), which has become the cornerstone for prevention of sickle-cell disease (SCD)-related vaso-occlusive crises. However, there are few large-scale reports on its long-term use and certain caregivers and patients have concerns about its safety. Following the licensing of HU in Europe for children and adults with severe forms of SCD, ESCORT-HU was designed as a Phase IV observational cohort study. It included 1906 participants, of whom 55% were adults. The most common hemoglobin (Hb) genotypes were HbSS (84.7%) and HbSβ+ (7.0%). The median duration of follow-up was 45 months, for a total of 7309 patient-years of observation. The dose of HU after 1 year was 20.6 mg/kg/d for children and 16.3 mg/kg/d for adults. There was a statistically significant decrease in the number of vaso-occlusive episodes lasting >48 h, acute chest syndrome episodes, hospitalizations, and the percentage of patients requiring blood transfusions within the first 12 months relative to the year before enrolment. Neutropenia and thrombocytopenia were the most commonly reported adverse effects. No new HU toxicity was identified. Overall, 125 pregnancies were reported in 101 women and no malformations were observed in the neonates. There were 12 pregnancies for partners of male patients treated with HU. One case of fatal myelodysplastic syndrome was reported, for which a causal association with HU could not be excluded. This cohort study of patients with SCD highlights the positive benefit-to-risk ratio of HU in children and adults.
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Affiliation(s)
- Mariane Montalembert
- Reference Centre for Sickle Cell Disease, Department of General Pediatrics and Pediatric Infectious Diseases Necker‐Enfants malades Hospital, Assistance Publique‐Hôpitaux de Paris (AP‐HP) Paris France
| | - Ersi Voskaridou
- Centre of Excellence in Rare Hematological Disease‐Hemoglobinopathies, Laiko General Hospital Athens Greece
| | - Lena Oevermann
- Department of Pediatric Oncology & Hematology Charité University Medicine, Berlin and Berlin Institute of Health Berlin Germany
| | - Giovanna Cannas
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Médecine Interne, Centre de Référence Constitutif: Syndromes Drépanocytaires Majeurs, Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erythropoïèse Lyon France
| | - Anoosha Habibi
- Sickle Cell Referral Center, Department of Internal Medicine Henri‐Mondor University Hospital‐UPEC, AP‐HP Créteil France
| | - Gylna Loko
- Centre hospitalier de la Martinique Fort‐de‐France Martinique France
| | - Laure Joseph
- Biotherapy Department Necker Children's Hospital, Assistance Publique‐Hôpitaux de Paris Paris France
| | | | - Pablo Bartolucci
- Sickle Cell Referral Center, Department of Internal Medicine Henri‐Mondor University Hospital‐UPEC, AP‐HP Créteil France
| | - Valentine Brousse
- Reference Centre for Sickle Cell Disease, Department of General Pediatrics and Pediatric Infectious Diseases Necker‐Enfants malades Hospital, Assistance Publique‐Hôpitaux de Paris (AP‐HP) Paris France
| | - Frédéric Galactéros
- Sickle Cell Referral Center, Department of Internal Medicine Henri‐Mondor University Hospital‐UPEC, AP‐HP Créteil France
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Colombatti R, Casale M, Russo G. Disease burden and quality of life of in children with sickle cell disease in Italy: time to be considered a priority. Ital J Pediatr 2021; 47:163. [PMID: 34325732 PMCID: PMC8323323 DOI: 10.1186/s13052-021-01109-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/18/2021] [Indexed: 01/12/2023] Open
Abstract
The objective of the present article is to highlight the need for attention to Quality of Life of patients with Sickle Cell Disease living in Italy. The transformation of sickle cell disease from a severe life-threatening disease of childhood into a chronic, lifelong condition due to the significant improvements in care and treatment options, imposes increasing new challenges to health care providers and patients. Patients now face physical, psychosocial and emotional challenges throughout their lives. They generally have to receive chronic treatments and regular multidisciplinary monitoring which increase social and emotional burden rendering adherence to treatment sometimes complicated. A chronic disease impacts all aspects of patients’ lives, not only the physical one, but also the social and emotional aspects as well as the educational and working life. The entire “Quality of Life” is affected and recent evidence demonstrates the importance quality of life has for patients with chronic illness. The results of this review focus on emerging data regarding quality of life across the lifespan of patients with Sickle Cell Disease, and highlight the need for more action in this field in Italy, where recent immigration and improved care determine an increasing population of children with sickle cell disease being taken into long term care.
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Affiliation(s)
- Raffaella Colombatti
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Maddalena Casale
- Department of Women, Child and General and Specialized Surgery, University "Luigi Vanvitelli", Naples, Italy
| | - Giovanna Russo
- Pediatric Hemato-Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
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16
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Silva CM, de Souza Medina S, de Melo Campos P, Costa FF, Saad STO, Benites BD. Platelet counts on peripheral blood and Mean Platelet Volume as markers of clinical severity in Sickle Cell Disease. Blood Cells Mol Dis 2021; 91:102592. [PMID: 34273711 DOI: 10.1016/j.bcmd.2021.102592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022]
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17
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Gour A, Dogra A, Kour D, Singh G, Kumar A, Nandi U. Effect of Concomitant Hydroxyurea Therapy with Rutin and Gallic Acid: Integration of Pharmacokinetic and Pharmacodynamic Approaches. ACS OMEGA 2021; 6:14542-14550. [PMID: 34124477 PMCID: PMC8190911 DOI: 10.1021/acsomega.1c01518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/13/2021] [Indexed: 05/28/2023]
Abstract
Hydroxyurea (HU) is the first-ever approved drug by USFDA for sickle cell anemia (SCA). However, its treatment is associated with severe side effects like myelosuppression. Current studies are focused on the supplementation therapy for symptomatic management of SCA. In the present study, we aimed to explore rutin's and gallic acid's potential individually, for concomitant therapy with HU using pharmacokinetic and pharmacodynamic approaches since there is no such precedent till date. In vivo pharmacokinetic studies of HU in rats showed that rutin could be safely co-administered with HU, while gallic acid significantly raised the plasma concentration of HU. Both the phytochemicals did not have any marked inhibitory effect on urease but have considerable effects on horseradish peroxidase enzyme. The experimental phytoconstituents displayed a very low propensity to cause in vitro hemolysis. Gallic acid markedly enhanced the HU-induced decrease in lymphocyte proliferation. A substantial improvement by rutin or gallic acid was observed in HU-induced reduction of the main hematological parameters in rats. Combined treatment of HU with rutin and gallic acid reduced serum levels of both IL-6 and IL-17A. Overall, both rutin and gallic acid are found to have promising phytotherapy potential with HU. Further exploration needs to be done on both candidates for use as phytotherapeutics for SCA.
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Affiliation(s)
- Abhishek Gour
- PK-PD,
Toxicology and Formulation Division, CSIR-Indian
Institute of Integrative Medicine, Jammu, Jammu and Kashmir 180001, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh 201 002, India
| | - Ashish Dogra
- PK-PD,
Toxicology and Formulation Division, CSIR-Indian
Institute of Integrative Medicine, Jammu, Jammu and Kashmir 180001, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh 201 002, India
| | - Dilpreet Kour
- PK-PD,
Toxicology and Formulation Division, CSIR-Indian
Institute of Integrative Medicine, Jammu, Jammu and Kashmir 180001, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh 201 002, India
| | - Gurdarshan Singh
- PK-PD,
Toxicology and Formulation Division, CSIR-Indian
Institute of Integrative Medicine, Jammu, Jammu and Kashmir 180001, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh 201 002, India
| | - Ajay Kumar
- PK-PD,
Toxicology and Formulation Division, CSIR-Indian
Institute of Integrative Medicine, Jammu, Jammu and Kashmir 180001, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh 201 002, India
| | - Utpal Nandi
- PK-PD,
Toxicology and Formulation Division, CSIR-Indian
Institute of Integrative Medicine, Jammu, Jammu and Kashmir 180001, India
- Academy
of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh 201 002, India
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18
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American Society of Hematology 2020 guidelines for sickle cell disease: prevention, diagnosis, and treatment of cerebrovascular disease in children and adults. Blood Adv 2021; 4:1554-1588. [PMID: 32298430 DOI: 10.1182/bloodadvances.2019001142] [Citation(s) in RCA: 208] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/03/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Central nervous system (CNS) complications are among the most common, devastating sequelae of sickle cell disease (SCD) occurring throughout the lifespan. OBJECTIVE These evidence-based guidelines of the American Society of Hematology are intended to support the SCD community in decisions about prevention, diagnosis, and treatment of the most common neurological morbidities in SCD. METHODS The Mayo Evidence-Based Practice Research Program supported the guideline development process, including updating or performing systematic evidence reviews. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE evidence-to-decision frameworks, to assess evidence and make recommendations. RESULTS The panel placed a higher value on maintaining cognitive function than on being alive with significantly less than baseline cognitive function. The panel developed 19 recommendations with evidence-based strategies to prevent, diagnose, and treat CNS complications of SCD in low-middle- and high-income settings. CONCLUSIONS Three of 19 recommendations immediately impact clinical care. These recommendations include: use of transcranial Doppler ultrasound screening and hydroxyurea for primary stroke prevention in children with hemoglobin SS (HbSS) and hemoglobin Sβ0 (HbSβ0) thalassemia living in low-middle-income settings; surveillance for developmental delay, cognitive impairments, and neurodevelopmental disorders in children; and use of magnetic resonance imaging of the brain without sedation to detect silent cerebral infarcts at least once in early-school-age children and once in adults with HbSS or HbSβ0 thalassemia. Individuals with SCD, their family members, and clinicians should become aware of and implement these recommendations to reduce the burden of CNS complications in children and adults with SCD.
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19
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Jordan LC, DeBaun MR, Donahue MJ. Advances in neuroimaging to improve care in sickle cell disease. Lancet Neurol 2021; 20:398-408. [PMID: 33894194 DOI: 10.1016/s1474-4422(20)30490-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 12/26/2022]
Abstract
Sickle cell disease is associated with progressive and increased neurological morbidity throughout the lifespan. In people with sickle cell anaemia (the most common and severe type of sickle cell disease), silent cerebral infarcts are found in more than a third of adolescents by age 18 years and roughly half of young adults by age 30 years, many of whom have cognitive impairment despite having few or no conventional stroke risk factors. Common anatomical neuroimaging in individuals with sickle disease can assess structural brain injury, such as stroke and silent cerebral infarcts; however, emerging advanced neuroimaging methods can provide novel insights into the pathophysiology of sickle cell disease, including insights into the cerebral haemodynamic and metabolic contributors of neurological injury. Advanced neuroimaging methods, particularly methods that report on aberrant cerebral blood flow and oxygen delivery, have potential for triaging patients for appropriate disease-modifying or curative therapies before they have irreversible neurological injury, and for confirming the benefit of new therapies on brain health in clinical trials.
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Affiliation(s)
- Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Michael R DeBaun
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus J Donahue
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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20
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Ali EH, Alkindi S, Osman MA, Hilali W, Mirgani HM, Adam G, Morsi MM, Hussein IS, Ghebremeskel K. Nutritional and Hematological Status of Sudanese Women of Childbearing Age with Steady-state Sickle Cell Anemia. Oman Med J 2021; 36:e270. [PMID: 34164159 PMCID: PMC8204634 DOI: 10.5001/omj.2021.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 10/11/2020] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES We sought to investigate the nutritional and hematological status of Sudanese women of childbearing age with sickle cell anemia (SCA). Anthropometry and hematology were used to assess nutritional status and health and disease conditions, respectively. METHODS Women with steady-state (HbSS, n = 39; age = 19.0±2.7) and without (HbAA, n = 36; age, 19.8±2.7) SCA were recruited during a routine visit to the Hematology Clinic, Ibn-Auf Teaching Hospital, Khartoum, Sudan. RESULTS The two groups of women lived in similar environmental conditions and ate similar diets three times a day. However, despite taking regular meals, the women with sickle anemia were thinner and lighter (p < 0.001) and shorter (p = 0.002) compared with those who do not have the disease. Also, they had higher levels of mean corpuscular hemoglobin (Hb) concentration and white cell count (p < 0.001), mean corpuscular volume (p = 0.003), and platelet (p = 0.002) and lower packed cell volume and Hb (p < 0.001). There was no difference in levels of anthropometric and hematological variables between the hydroxyurea treated and untreated SCA patients (p > 0.050). CONCLUSIONS The low anthropometric (height, weight, and body mass index) and abnormal hematological values in the women with SCA in steady-state reflect sustained nutritional insults inflected by the disease and poverty. Tailored nutritional counseling/advice must be an integral part of managing patients with SCA. Such advice is particularly vital for women of childbearing age because of the adverse effects of prepregnancy nutritional deficiency on outcomes.
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Affiliation(s)
- Eltigani Hassan Ali
- Lipidomics and Nutrition Research Centre, School of Human Sciences, London Metropolitan University, London, UK
| | - Salam Alkindi
- Department of Hematology, Sultan Qaboos University, Muscat, Oman
| | - Mohamed A. Osman
- Department of Biochemistry, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Wafa Hilali
- Department of Haematology, Ibn Auf Teaching Hospital, Khartoum, Sudan
| | - Hind M. Mirgani
- Department of Haematology, Ibn Auf Teaching Hospital, Khartoum, Sudan
| | - Gareeba Adam
- Department of Educational Technology, Faculty of Higher Studies, Al-Zaiem Al Azhari University, Khartoum, Sudan
| | - Magdi M. Morsi
- Directorate of Planning, Ministry of Health, Muscat, Oman
| | - Izzeldin S. Hussein
- Department of Micronutrient, Iodine Global Network, Middle East and North Africa
| | - Kebreab Ghebremeskel
- Lipidomics and Nutrition Research Centre, School of Human Sciences, London Metropolitan University, London, UK
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21
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Alzahrani F, Albaz GF, AlSinan F, Alzuhayri J, Barnawi ZM, Melebari N, Al Twairgi TM. Hydroxyurea Use Among Children With Sickle Cell Disease at King Abdulaziz University Hospital in Jeddah City. Cureus 2021; 13:e13453. [PMID: 33767937 PMCID: PMC7984494 DOI: 10.7759/cureus.13453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Sickle cell disease (SCD) is an autosomal recessive hemoglobinopathy that is very common and causes a great burden in Saudi Arabia and worldwide. This study aims to determine the frequency and benefits of using hydroxyurea in treating children with SCD in King Abdulaziz University Hospital (KAUH) in Saudi Arabia. Method This retrospective observational study included all SCD patients, males and females, who were following up in KAUH and were less than 18 years old. Patients on chronic transfusion therapy or who had previous stem cell transplantation were excluded from the study. The study was approved by the unit of biomedical ethics in KAUH, Jeddah. Result The study included 102 SCD patients; the median age of the sample was 7.5±4.2, with the majority being female (58 patients; 56.9%). Hydroxyurea users among participants in the study were 62 patients (60.8%). Thirty-seven (37) of the patients using hydroxyurea had an increase in the mean corpuscular volume (MCV). There was a decrease in the level of white blood cells (WBCs) and neutrophil count from 15.81±10.24 and 48.31±23.23% to 12.48±5.48 and 40.81±15.78%, respectively. Platelet count showed an increase from 345.4±2.1096 to 359.162±199.87 after starting hydroxyurea. The incidence of vaso-occlusive crisis (VOC) increased after hydroxyurea initiation from 4.555±4.08 to 6.288±9.80. Moreover, the frequency of blood transfusion in patients using hydroxyurea was statistically significant as p-value = 0.048. Conclusion In conclusion, our results showed significant clinical and laboratory benefits of hydroxyurea in children with SCD. Hydroxyurea has been shown to reduce the frequency of VOC and blood transfusion in patients with SCD.
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Affiliation(s)
| | | | - Fatima AlSinan
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, SAU
| | - Jumana Alzuhayri
- Faculty of Science: Biochemistry, King Abdul-Aziz University, Jeddah, SAU
| | | | - Nouf Melebari
- Health Education, Umm Al Qura University, Makkah, SAU
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22
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Ferreira TFA, Dos Santos APT, Leal AS, de Araújo Pereira G, Silva SS, Moraes-Souza H. Chronic osteo-articular changes in patients with sickle cell disease. Adv Rheumatol 2021; 61:11. [PMID: 33608055 DOI: 10.1186/s42358-021-00169-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is an autosomal recessive genetic disease in which a mutation occurs in the β-globin chain gene, resulting in abnormal hemoglobin levels. In an environment with reduced oxygen concentration, red blood cells change their conformation, resulting in chronic hemolysis and consequent anemia and vaso-occlusive crises with injuries to several organs, with a significant impairment of the osteoarticular system. This study aimed to verify the chronic osteoarticular alterations and their association with clinical and laboratory characteristics of patients with SCD with a more severe phenotype (SS and Sβ0), on a steady-state fasis. METHODS Fifty-five patients were referred to a medical consultation with a specialized assessment of the locomotor system, followed by laboratory tests and radiographic examinations. RESULTS In total, 74.5% patients had hemoglobinopathy SS; 67.3% were female; and 78.2% were non-whites. The mean patient age was 30.5 years. Most patients (61.8%) reported up to three crises per year, with a predominance of high-intensity pain (65.5%). Radiographic alterations were present in 80% patients. A total of 140 lesions were identified, most which were located in the spine, femur, and shoulders. Most lesions were osteonecrosis and osteoarthritis and were statistically associated with the non-use of hydroxyurea. CONCLUSIONS There was a high prevalence of chronic osteoarticular alterations, which was statistically associated only with the non-regular use of hydroxyurea.
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Affiliation(s)
- Taciana Fernandes Araújo Ferreira
- Clinical Hospital of Federal University Triângulo Mineiro, Functional Units Rom, Av. Getúlio Guaritá, 130, B. Nossa Senhora da Abadia, CEP 38.025-440, Uberaba, MG, Brazil.
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23
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Vinhaes CL, Teixeira RS, Monteiro-Júnior JAS, Tibúrcio R, Cubillos-Angulo JM, Arriaga MB, Sabarin AG, de Souza AJ, Silva JJ, Lyra IM, Ladeia AM, Andrade BB. Hydroxyurea treatment is associated with reduced degree of oxidative perturbation in children and adolescents with sickle cell anemia. Sci Rep 2020; 10:18982. [PMID: 33149225 PMCID: PMC7642412 DOI: 10.1038/s41598-020-76075-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/16/2020] [Indexed: 01/16/2023] Open
Abstract
Sickle cell anemia (SCA) is the most common inherited hemolytic anemia worldwide. Here, we performed an exploratory study to investigate the systemic oxidative stress in children and adolescents with SCA. Additionally, we evaluated the potential impact of hydroxyurea therapy on the status of oxidative stress in a case–control study from Brazil. To do so, a panel containing 9 oxidative stress markers was measured in plasma samples from a cohort of 47 SCA cases and 40 healthy children and adolescents. Among the SCA patients, 42.5% were undertaking hydroxyurea. Multidimensional analysis was employed to describe disease phenotypes. Our results demonstrated that SCA is associated with increased levels of oxidative stress markers, suggesting the existence of an unbalanced inflammatory response in peripheral blood. Subsequent analyses revealed that hydroxyurea therapy was associated with diminished oxidative imbalance in SCA patients. Our findings reinforce the idea that SCA is associated with a substantial dysregulation of oxidative responses which may be dampened by treatment with hydroxyurea. If validated by larger prospective studies, our observations argue that reduction of oxidative stress may be a main mechanism through which hydroxyurea therapy attenuates the tissue damage and can contribute to improved clinical outcomes in SCA.
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Affiliation(s)
- Caian L Vinhaes
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, 40296-710, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, 41810-710, Brazil.,School of Medicine, Faculdade de Tecnologia E Ciências (UniFTC), Salvador, 41741-590, Brazil
| | - Rozana S Teixeira
- Bahiana School of Medicine and Public Health, Bahia Foundation for the Development of Sciences, Salvador, 40290-000, Brazil.,School of Medicine, Federal University of Bahia, Salvador, 40110-100, Brazil
| | - Jay A S Monteiro-Júnior
- Bahiana School of Medicine and Public Health, Bahia Foundation for the Development of Sciences, Salvador, 40290-000, Brazil
| | - Rafael Tibúrcio
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, 40296-710, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, 41810-710, Brazil.,School of Medicine, Federal University of Bahia, Salvador, 40110-100, Brazil
| | - Juan M Cubillos-Angulo
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, 40296-710, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, 41810-710, Brazil.,School of Medicine, Federal University of Bahia, Salvador, 40110-100, Brazil
| | - María B Arriaga
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, 40296-710, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, 41810-710, Brazil.,School of Medicine, Federal University of Bahia, Salvador, 40110-100, Brazil
| | - Adrielle G Sabarin
- Bahiana School of Medicine and Public Health, Bahia Foundation for the Development of Sciences, Salvador, 40290-000, Brazil
| | - Amâncio J de Souza
- Bahiana School of Medicine and Public Health, Bahia Foundation for the Development of Sciences, Salvador, 40290-000, Brazil
| | - Jacqueline J Silva
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, 40296-710, Brazil.,Bahiana School of Medicine and Public Health, Bahia Foundation for the Development of Sciences, Salvador, 40290-000, Brazil
| | - Isa M Lyra
- University Salvador (UNIFACS), Laureate International Universities, Salvador, 41720-200, Brazil
| | - Ana Marice Ladeia
- Bahiana School of Medicine and Public Health, Bahia Foundation for the Development of Sciences, Salvador, 40290-000, Brazil.,Catholic University of Salvador, Salvador, 41740-090, Brazil
| | - Bruno B Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, 40296-710, Brazil. .,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, 41810-710, Brazil. .,School of Medicine, Faculdade de Tecnologia E Ciências (UniFTC), Salvador, 41741-590, Brazil. .,Bahiana School of Medicine and Public Health, Bahia Foundation for the Development of Sciences, Salvador, 40290-000, Brazil. .,School of Medicine, Federal University of Bahia, Salvador, 40110-100, Brazil. .,University Salvador (UNIFACS), Laureate International Universities, Salvador, 41720-200, Brazil.
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24
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Pinto VM, Balocco M, Quintino S, Forni GL. Sickle cell disease: a review for the internist. Intern Emerg Med 2019; 14:1051-1064. [PMID: 31385153 DOI: 10.1007/s11739-019-02160-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 07/24/2019] [Indexed: 12/22/2022]
Abstract
Sickle cell disease (SCD) is the most important hemoglobinopathy worldwide in terms of frequency and social impact, recently recognized as a global public health problem by the World Health Organization. It is a monogenic but multisystem disorder with high morbidity and mortality. Vaso-occlusion, hemolytic anemia and vasculopathy are the hallmarks of SCD pathophysiology. This review focuses both on "time-dependent" acute clinical manifestations of SCD and chronic complications commonly described in adults with SCD. The review covers a broad spectrum of topics concerning current management of SCD targeted at the internists and emergency specialists who are increasingly involved in the care of acute and chronic complications of SCD patients.
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Affiliation(s)
- Valeria Maria Pinto
- Centro della Microcitemia E Delle Anemie Congenite Ente Ospedaliero Ospedali Galliera, Via Volta 6, 16128, Genoa, Italy
| | - Manuela Balocco
- Centro della Microcitemia E Delle Anemie Congenite Ente Ospedaliero Ospedali Galliera, Via Volta 6, 16128, Genoa, Italy
| | - Sabrina Quintino
- Centro della Microcitemia E Delle Anemie Congenite Ente Ospedaliero Ospedali Galliera, Via Volta 6, 16128, Genoa, Italy
| | - Gian Luca Forni
- Centro della Microcitemia E Delle Anemie Congenite Ente Ospedaliero Ospedali Galliera, Via Volta 6, 16128, Genoa, Italy.
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25
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Jose J, Elsadek RA, Jimmy B, George P. Hydroxyurea: Pattern of Use, Patient Adherence, and Safety Profile in Patients with Sickle Cell Disease in Oman. Oman Med J 2019; 34:327-335. [PMID: 31360322 PMCID: PMC6642718 DOI: 10.5001/omj.2019.64] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/14/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Many barriers contribute to the underutilization of hydroxyurea (HU) in the treatment of sickle cell disease (SCD), and adherence to its use is often reported to be suboptimal. It is important to have information on the safety of HU in patients with SCD. Our study assessed the pattern of use, patients' adherence to medication, discontinuation of use, and safety of HU in patients with SCD. METHODS This cross-sectional study was conducted in the department of medicine of a referral hospital in Oman over five months and included a review of patient files and patient interview. Approval was obtained from the Regional Research and Ethics Committee of the A'Dakhiliyah Governorate and the hospital administration. The parameters were compared between groups using the chi-square test. RESULTS Of 298 patients studied, 128 (43.0%) had used HU at some points. The difference in the prevalence of HU use was statistically significant based only on age (p = 0.014), with younger patients more likely to be currently using HU or used HU in the past. The majority of patients were adherent (82.5%) based on self-reported adherence. The prevalence of discontinuation (temporary or permanent) of HU use was high (57.0%), and suspected adverse drug reaction (ADR) was the most common reason. Among those who had never used HU, 33.7% of patients had an indication for the initiation of HU. A quarter of patients who used HU developed a suspected ADR, with blood abnormalities being the commonest. The duration of HU use influenced ADR prevalence (p = 0.015). CONCLUSIONS Among the current users of HU, the majority of the patients were adherent based on self-reported medication adherence. The prevalence of discontinuation of HU use and instances of non-initiation of HU among those indicated were high. A larger study, ideally of a prospective nature, in various governorates of Oman, would provide a wider picture at the national level.
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Affiliation(s)
- Jimmy Jose
- School of Pharmacy, University of Nizwa, Nizwa, Oman
| | | | - Beena Jimmy
- School of Pharmacy, University of Nizwa, Nizwa, Oman
| | - Prasad George
- Department of General Medicine, Nizwa Hospital, Nizwa, Oman
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26
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EHA Research Roadmap on Hemoglobinopathies and Thalassemia: An Update. Hemasphere 2019; 3:e208. [PMID: 31723835 PMCID: PMC6746021 DOI: 10.1097/hs9.0000000000000208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/11/2019] [Indexed: 12/13/2022] Open
Abstract
The inherited disorders of hemoglobin, which include sickle cell disease and thalassemias, are the most common and widespread distributed monogenic disorders. Due to a selective advantage in malaria regions, these hemoglobin defects are particularly frequent in Africa, Asia, or in the Mediterranean areas, where malaria was endemic until the last century. In recent decades, the globalization of migration has contributed to generate multiethnic European societies. Due to migration from countries or regions with high hemoglobinopathy frequencies such as Africa, Middle East, or Asia, large numbers of patients with these disorders are living in almost every European country today. Furthermore, the numbers are increasing because of increasing refugee flows toward Europe. Additional requirements are the development of European recommendations and guidelines for diagnosis and effective therapeutic approaches. These, together with the advancement of clinical trials using new drugs and therapeutic procedures could ameliorate the quality of life of patients affected with these diseases and increase their life expectancy. Lastly, coordinated efforts should be made to develop diagnostic pathways for thalassemias and hemoglobinopathies, in order to plan interventions, including prenatal diagnosis and cure. For these reasons, the development of new tools to reliably diagnose anemias is urgently needed and fits well with the needs of personalized medicine. In the last 15 years, hematology research has made many big leaps forward. Our general aim will be to solve several hematologic problems using these new approaches. We expect that the development of such a diagnostic tool will improve timely diagnosis throughout Europe, especially in those countries where it is difficult to gain access to "classical" diagnostic tests.
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Hirtz D, Kirkham FJ. Sickle Cell Disease and Stroke. Pediatr Neurol 2019; 95:34-41. [PMID: 30948147 DOI: 10.1016/j.pediatrneurol.2019.02.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 01/04/2023]
Abstract
Cerebral infarction is a common complication of sickle cell disease and may manifest as overt stroke or cognitive impairment associated with "silent" cerebral infarction on magnetic resonance imaging. Vasculopathy may be diagnosed on transcranial Doppler or magnetic resonance angiography. The risk factors in sickle cell disease for cognitive impairment, overt ischemic stroke, silent cerebral infarction, overt hemorrhagic stroke, and vasculopathy defined by transcranial Doppler or magnetic resonance angiography overlap, with severe acute and chronic anemia, acute chest crisis, reticulocytosis, and low oxygen saturation reported with the majority. However, there are differences reported in different cohorts, which may reflect age, geographic location, or neuroimaging techniques, for example, magnetic resonance imaging field strength. Regular blood transfusion reduces, but does not abolish, the risk of neurological complications in children with sickle cell disease and either previous overt stroke or silent cerebral infarction or abnormal transcranial Doppler. There are relatively few data on the use of hydroxyurea or other management strategies. Early assessment of the risk of neurocognitive complications is likely to become increasingly important in the management of sickle cell disease.
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Affiliation(s)
- Deborah Hirtz
- University of Vermont School of Medicine, Burlington, Vermont
| | - Fenella J Kirkham
- Developmental Neurosciences Section and Biomedical Research Unit, Clinical and Experimental Sciences, University of Southampton, UCL Great Ormond Street Institute of Child Health, London, UK.
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28
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Russo G, De Franceschi L, Colombatti R, Rigano P, Perrotta S, Voi V, Palazzi G, Fidone C, Quota A, Graziadei G, Pietrangelo A, Pinto V, Ruffo GB, Sorrentino F, Venturelli D, Casale M, Ferrara F, Sainati L, Cappellini MD, Piga A, Maggio A, Forni GL. Current challenges in the management of patients with sickle cell disease - A report of the Italian experience. Orphanet J Rare Dis 2019; 14:120. [PMID: 31146777 PMCID: PMC6543611 DOI: 10.1186/s13023-019-1099-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/19/2019] [Indexed: 12/22/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited red blood cell disorder caused by a structural abnormality of hemoglobin called sickle hemoglobin (HbS). Clinical manifestations of SCD are mainly characterized by chronic hemolysis and acute vaso-occlusive crisis, which are responsible for severe acute and chronic organ damage. SCD is widespread in sub-Saharan Africa, in the Middle East, Indian subcontinent, and some Mediterranean regions. With voluntary population migrations, people harboring the HbS gene have spread globally. In 2006, the World Health Organization recognized hemoglobinopathies, including SCD, as a global public health problem and urged national health systems worldwide to design and establish programs for the prevention and management of SCD. Herein we describe the historical experience of the network of hemoglobinopathy centers and their approach to SCD in Italy, a country where hemoglobinopathies have a high prevalence and where SCD, associated with different genotypes including ß-thalassemia, is present in the native population.
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Affiliation(s)
- Giovanna Russo
- Oncoematologia Pediatrica, Azienda Policlinico-Vittorio Emanuele, Università di Catania, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Lucia De Franceschi
- Dipartimento di Medicina, Sezione Medicina Interna, Università di Verona, Policlinico GB Rossi, AOUI, Verona, Italy
| | - Raffaella Colombatti
- Clinica di Oncoematologia Pediatrica, Dipartimento della Salute della Donna e del Bambino Azienda Ospedaliera, Università di Padova, Padova, Italy
| | - Paolo Rigano
- U.O.C Ematologia e Malattie Rare del Sangue e degli Organi Ematopoietici-P.O. Cervello Palermo, Palermo, Italy
| | - Silverio Perrotta
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università̀ degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Vincenzo Voi
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Ospedale San Luigi Gonzaga, Orbassano, Italy
| | - Giovanni Palazzi
- Dipartimento Integrato Materno Infantile U. O. Complessa di Pediatria Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Carmelo Fidone
- Unità operativa semplice Studio Emoglobinopatie Simt, Ragusa, Italy
| | | | - Giovanna Graziadei
- UOC di Medicina Generale, Centro Malattie Rare Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Pad, Granelli, Milano, Italy
| | - Antonello Pietrangelo
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Valeria Pinto
- Centro della Microcitemia e delle Anemie Congenite, Ospedale Galliera, Via Volta 6, 16128, Genova, Italy
| | | | - Francesco Sorrentino
- U.O. Talassemici Centro Anemia Rare e Disturbi del metabolismo del Ferro ASL ROMA 2 Ospedale S Eugenio, Roma, Italy
| | - Donatella Venturelli
- Struttura Complessa di Immuno-trasfusionale Azienda Ospedaliero, Universitaria di Modena, Modena, Italy
| | - Maddalena Casale
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università̀ degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Francesca Ferrara
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Laura Sainati
- Clinica di Oncoematologia Pediatrica, Dipartimento della Salute della Donna e del Bambino Azienda Ospedaliera, Università di Padova, Padova, Italy
| | - Maria Domenica Cappellini
- UOC di Medicina Generale, Centro Malattie Rare Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Pad, Granelli, Milano, Italy
| | - Antonio Piga
- Struttura Complessa di Pediatria-Microcitemie dell'Ospedale San Luigi di Orbassano, Orbassano, TO, Italy
| | - Aurelio Maggio
- U.O.C Ematologia e Malattie Rare del Sangue e degli Organi Ematopoietici-P.O. Cervello Palermo, Palermo, Italy
| | - Gian Luca Forni
- Centro della Microcitemia e delle Anemie Congenite, Ospedale Galliera, Via Volta 6, 16128, Genova, Italy.
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Hydroxyurea reduces cerebral metabolic stress in patients with sickle cell anemia. Blood 2019; 133:2436-2444. [PMID: 30858231 DOI: 10.1182/blood-2018-09-876318] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/02/2019] [Indexed: 12/20/2022] Open
Abstract
Chronic transfusion therapy (CTT) prevents stroke in selected patients with sickle cell anemia (SCA). We have shown that CTT mitigates signatures of cerebral metabolic stress, reflected by elevated oxygen extraction fraction (OEF), which likely drives stroke risk reduction. The region of highest OEF falls within the border zone, where cerebral blood flow (CBF) nadirs; OEF in this region was reduced after CTT. The neuroprotective efficacy of hydroxyurea (HU) remains unclear. To test our hypothesis that patients receiving HU therapy have lower cerebral metabolic stress compared with patients not receiving disease-modifying therapy, we prospectively obtained brain magnetic resonance imaging scans with voxel-wise measurements of CBF and OEF in 84 participants with SCA who were grouped by therapy: no disease-modifying therapy, HU, or CTT. There was no difference in whole-brain CBF among the 3 cohorts (P = .148). However, whole-brain OEF was significantly different (P < .001): participants without disease-modifying therapy had the highest OEF (median 42.9% [interquartile range (IQR) 39.1%-49.1%]), followed by HU treatment (median 40.7% [IQR 34.9%-43.6%]), whereas CTT treatment had the lowest values (median 35.3% [IQR 32.2%-38.9%]). Moreover, the percentage of white matter at highest risk for ischemia, defined by OEF greater than 40% and 42.5%, was lower in the HU cohort compared with the untreated cohort (P = .025 and P = .034 respectively), but higher compared with the CTT cohort (P = .018 and P = .029 respectively). We conclude that HU may offer neuroprotection by mitigating cerebral metabolic stress in patients with SCA, but not to the same degree as CTT.
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Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2019; 50:e51-e96. [DOI: 10.1161/str.0000000000000183] [Citation(s) in RCA: 240] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Access to emergency departments for acute events and identification of sickle cell disease in refugees. Blood 2019; 133:2100-2103. [PMID: 30745303 DOI: 10.1182/blood-2018-09-876508] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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New Therapeutic Options for the Treatment of Sickle Cell Disease. Mediterr J Hematol Infect Dis 2019; 11:e2019002. [PMID: 30671208 PMCID: PMC6328043 DOI: 10.4084/mjhid.2019.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/11/2018] [Indexed: 02/08/2023] Open
Abstract
Sickle cell disease (SCD; ORPHA232; OMIM # 603903) is a chronic and invalidating disorder distributed worldwide, with high morbidity and mortality. Given the disease complexity and the multiplicity of pathophysiological targets, development of new therapeutic options is critical, despite the positive effects of hydroxyurea (HU), for many years the only approved drug for SCD. New therapeutic strategies might be divided into (1) pathophysiology-related novel therapies and (2) innovations in curative therapeutic options such as hematopoietic stem cell transplantation and gene therapy. The pathophysiology related novel therapies are: a) Agents which reduce sickling or prevent sickle red cell dehydration; b) Agents targeting SCD vasculopathy and sickle cell-endothelial adhesive events; c) Anti-oxidant agents. This review highlights new therapeutic strategies in SCD and discusses future developments, research implications, and possible innovative clinical trials.
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Jordan LC, Kassim AA, Donahue MJ, Juttukonda MR, Pruthi S, Davis LT, Rodeghier M, Lee CA, Patel NJ, DeBaun MR. Silent infarct is a risk factor for infarct recurrence in adults with sickle cell anemia. Neurology 2018; 91:e781-e784. [PMID: 30054441 DOI: 10.1212/wnl.0000000000006047] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/18/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Because of the high prevalence of silent cerebral infarcts (SCIs) in adults with sickle cell anemia (SCA) and lack of information to guide treatment strategies, we evaluated the risk of recurrent SCIs and overt stroke in adults with SCA with preexisting SCI. METHODS This observational study included adults with SCA (HbSS or Sβ0 thalassemia) aged 18 to 40 years. Participants received 3-tesla brain MRI and a detailed neurologic examination. Time-to-event analysis assessed those with or without baseline SCI and with new or progressive infarcts. The incidence rate of new events was compared by log-rank test. Univariable Cox regression assessed the association of SCI with infarct progression. RESULTS Among adults with SCA with 2 MRIs and at least 6 months between MRIs (n = 54, mean interval = 2.5 years), 43% had SCI at baseline. Of participants with baseline SCI, 30% had new or progressive SCI over 2.5 years compared to 6% with no SCI at baseline; no participant had an overt stroke. New SCIs at follow-up were present in 12.9 per 100 patient-years with existing SCI compared with 2.4 per 100 patient-years without prior SCI (log-rank test, p = 0.021). No statistically significant differences were seen among those with or without baseline SCI in use of hydroxyurea therapy, hydroxyurea dose, or other stroke risk factors. The presence of SCI was associated with increased hazard of a new or progressive infarct (hazard ratio 5.27, 95% confidence interval 1.09-25.51, p = 0.039). CONCLUSIONS Silent infarcts in adults with SCA are common and are a significant risk factor for future silent infarcts.
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Affiliation(s)
- Lori C Jordan
- From the Department of Pediatrics, Division of Pediatric Neurology (L.C.J., C.A.L., N.J.P.), Vanderbilt-Meharry Sickle Cell Center for Excellence (A.A.K., M.R.D.), Departments of Radiology and Radiological Sciences (M.J.D., M.R.J.), Neurology (M.J.D.), and Psychiatry (M.J.D.), and Department of Radiology, Divisions of Pediatric Radiology and Neuroradiology (S.P.), and Department of Radiology, Division of Neuroradiology (L.T.D.), Vanderbilt University Medical Center, Nashville; Department of Physics and Astronomy (M.J.D.), Vanderbilt University, Nashville, TN; and Rodeghier Consultants (M.R.), Chicago, IL.
| | - Adetola A Kassim
- From the Department of Pediatrics, Division of Pediatric Neurology (L.C.J., C.A.L., N.J.P.), Vanderbilt-Meharry Sickle Cell Center for Excellence (A.A.K., M.R.D.), Departments of Radiology and Radiological Sciences (M.J.D., M.R.J.), Neurology (M.J.D.), and Psychiatry (M.J.D.), and Department of Radiology, Divisions of Pediatric Radiology and Neuroradiology (S.P.), and Department of Radiology, Division of Neuroradiology (L.T.D.), Vanderbilt University Medical Center, Nashville; Department of Physics and Astronomy (M.J.D.), Vanderbilt University, Nashville, TN; and Rodeghier Consultants (M.R.), Chicago, IL
| | - Manus J Donahue
- From the Department of Pediatrics, Division of Pediatric Neurology (L.C.J., C.A.L., N.J.P.), Vanderbilt-Meharry Sickle Cell Center for Excellence (A.A.K., M.R.D.), Departments of Radiology and Radiological Sciences (M.J.D., M.R.J.), Neurology (M.J.D.), and Psychiatry (M.J.D.), and Department of Radiology, Divisions of Pediatric Radiology and Neuroradiology (S.P.), and Department of Radiology, Division of Neuroradiology (L.T.D.), Vanderbilt University Medical Center, Nashville; Department of Physics and Astronomy (M.J.D.), Vanderbilt University, Nashville, TN; and Rodeghier Consultants (M.R.), Chicago, IL
| | - Meher R Juttukonda
- From the Department of Pediatrics, Division of Pediatric Neurology (L.C.J., C.A.L., N.J.P.), Vanderbilt-Meharry Sickle Cell Center for Excellence (A.A.K., M.R.D.), Departments of Radiology and Radiological Sciences (M.J.D., M.R.J.), Neurology (M.J.D.), and Psychiatry (M.J.D.), and Department of Radiology, Divisions of Pediatric Radiology and Neuroradiology (S.P.), and Department of Radiology, Division of Neuroradiology (L.T.D.), Vanderbilt University Medical Center, Nashville; Department of Physics and Astronomy (M.J.D.), Vanderbilt University, Nashville, TN; and Rodeghier Consultants (M.R.), Chicago, IL
| | - Sumit Pruthi
- From the Department of Pediatrics, Division of Pediatric Neurology (L.C.J., C.A.L., N.J.P.), Vanderbilt-Meharry Sickle Cell Center for Excellence (A.A.K., M.R.D.), Departments of Radiology and Radiological Sciences (M.J.D., M.R.J.), Neurology (M.J.D.), and Psychiatry (M.J.D.), and Department of Radiology, Divisions of Pediatric Radiology and Neuroradiology (S.P.), and Department of Radiology, Division of Neuroradiology (L.T.D.), Vanderbilt University Medical Center, Nashville; Department of Physics and Astronomy (M.J.D.), Vanderbilt University, Nashville, TN; and Rodeghier Consultants (M.R.), Chicago, IL
| | - Larry T Davis
- From the Department of Pediatrics, Division of Pediatric Neurology (L.C.J., C.A.L., N.J.P.), Vanderbilt-Meharry Sickle Cell Center for Excellence (A.A.K., M.R.D.), Departments of Radiology and Radiological Sciences (M.J.D., M.R.J.), Neurology (M.J.D.), and Psychiatry (M.J.D.), and Department of Radiology, Divisions of Pediatric Radiology and Neuroradiology (S.P.), and Department of Radiology, Division of Neuroradiology (L.T.D.), Vanderbilt University Medical Center, Nashville; Department of Physics and Astronomy (M.J.D.), Vanderbilt University, Nashville, TN; and Rodeghier Consultants (M.R.), Chicago, IL
| | - Mark Rodeghier
- From the Department of Pediatrics, Division of Pediatric Neurology (L.C.J., C.A.L., N.J.P.), Vanderbilt-Meharry Sickle Cell Center for Excellence (A.A.K., M.R.D.), Departments of Radiology and Radiological Sciences (M.J.D., M.R.J.), Neurology (M.J.D.), and Psychiatry (M.J.D.), and Department of Radiology, Divisions of Pediatric Radiology and Neuroradiology (S.P.), and Department of Radiology, Division of Neuroradiology (L.T.D.), Vanderbilt University Medical Center, Nashville; Department of Physics and Astronomy (M.J.D.), Vanderbilt University, Nashville, TN; and Rodeghier Consultants (M.R.), Chicago, IL
| | - Chelsea A Lee
- From the Department of Pediatrics, Division of Pediatric Neurology (L.C.J., C.A.L., N.J.P.), Vanderbilt-Meharry Sickle Cell Center for Excellence (A.A.K., M.R.D.), Departments of Radiology and Radiological Sciences (M.J.D., M.R.J.), Neurology (M.J.D.), and Psychiatry (M.J.D.), and Department of Radiology, Divisions of Pediatric Radiology and Neuroradiology (S.P.), and Department of Radiology, Division of Neuroradiology (L.T.D.), Vanderbilt University Medical Center, Nashville; Department of Physics and Astronomy (M.J.D.), Vanderbilt University, Nashville, TN; and Rodeghier Consultants (M.R.), Chicago, IL
| | - Niral J Patel
- From the Department of Pediatrics, Division of Pediatric Neurology (L.C.J., C.A.L., N.J.P.), Vanderbilt-Meharry Sickle Cell Center for Excellence (A.A.K., M.R.D.), Departments of Radiology and Radiological Sciences (M.J.D., M.R.J.), Neurology (M.J.D.), and Psychiatry (M.J.D.), and Department of Radiology, Divisions of Pediatric Radiology and Neuroradiology (S.P.), and Department of Radiology, Division of Neuroradiology (L.T.D.), Vanderbilt University Medical Center, Nashville; Department of Physics and Astronomy (M.J.D.), Vanderbilt University, Nashville, TN; and Rodeghier Consultants (M.R.), Chicago, IL
| | - Michael R DeBaun
- From the Department of Pediatrics, Division of Pediatric Neurology (L.C.J., C.A.L., N.J.P.), Vanderbilt-Meharry Sickle Cell Center for Excellence (A.A.K., M.R.D.), Departments of Radiology and Radiological Sciences (M.J.D., M.R.J.), Neurology (M.J.D.), and Psychiatry (M.J.D.), and Department of Radiology, Divisions of Pediatric Radiology and Neuroradiology (S.P.), and Department of Radiology, Division of Neuroradiology (L.T.D.), Vanderbilt University Medical Center, Nashville; Department of Physics and Astronomy (M.J.D.), Vanderbilt University, Nashville, TN; and Rodeghier Consultants (M.R.), Chicago, IL
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Di Maggio R, Hsieh MM, Zhao X, Calvaruso G, Rigano P, Renda D, Tisdale JF, Maggio A. Chronic Administration of Hydroxyurea (HU) Benefits Caucasian Patients with Sickle-Beta Thalassemia. Int J Mol Sci 2018; 19:ijms19030681. [PMID: 29495591 PMCID: PMC5877542 DOI: 10.3390/ijms19030681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/23/2018] [Accepted: 02/26/2018] [Indexed: 01/10/2023] Open
Abstract
In sickle cell disease (SCD), hydroxyurea (HU) treatment decreases the number of vaso-occlusive crisis (VOC) and acute chest syndrome (ACS) by increasing fetal hemoglobin (HbF). Data are lacking regarding the frequency of HU dose modification or whether sub-therapeutic doses (<15 mg/kg/day) are beneficial. We reviewed the medical records of 140 patients from 2010 to 2014. The laboratory parameters and SCD complications were compared between the first and last visits based on HU use. Fifty patients (36%) never took HU or suspended HU (“no HU” group). Among patients taking <15 mg/kg/day HU on their first visit, half remained at the same dose, and the other half increased to ≥15 mg/kg/day. Among patients taking ≥15 mg/kg/day, 17% decreased to <15 mg/kg/day, and 83% stayed at ≥15 mg/kg/day. The “no HU” group had fewer episodes of VOC and ACS. Both HU treatment groups had a reduction in both complications (p < 0.0001). This improvement was observed in all SCD phenotypes. The white blood cell (WBC) counts were found to be lower, and HbF increased in both HU groups (p = 0.004, 0.001). The maximal HbF response to HU in HbS/β+-thalassemia was 20%, similar to those observed for HbSS (19%) and HbS/β0-thalassemia (22%). HbS/β+-thalassemia could have a similar disease severity as HbSS or HbS/β0-thalassemia. Patients with HbS/β0-thalassemia or HbS/β+-thalassemia phenotypes responded to HU.
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Affiliation(s)
- Rosario Di Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, 90142 Palermo, Italy.
| | - Matthew M Hsieh
- Molecular and Clinical Hematology Branch, National Institute of Diabetes and Digestive and Kidney Diseases/National Heart, Lung, and Blood Institute, Bethesda, MD 20814, USA.
| | - Xiongce Zhao
- Office of Clinical Director, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20814, USA.
| | - Giuseppina Calvaruso
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, 90142 Palermo, Italy.
| | - Paolo Rigano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, 90142 Palermo, Italy.
| | - Disma Renda
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, 90142 Palermo, Italy.
| | - John F Tisdale
- Molecular and Clinical Hematology Branch, National Institute of Diabetes and Digestive and Kidney Diseases/National Heart, Lung, and Blood Institute, Bethesda, MD 20814, USA.
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, 90142 Palermo, Italy.
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