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Lad H, Naskar S, Punyasri Pasupuleti SKDB, Nahrel R, Sihare P, Chandak GR, Patra PK. Evaluation of pharmacological efficacy and safety of hydroxyurea in sickle cell disease: Study of a pediatric cohort from Chhattisgarh, India. Pediatr Hematol Oncol 2022; 40:395-406. [PMID: 36226857 DOI: 10.1080/08880018.2022.2126042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Sickle cell disease (SCD) is a disease of abnormal hemoglobin associated with severe clinical phenotype and recurrent complications. Hydroxyurea (HU) is one of the US-FDA approved and commonly used drug for the treatment of adult SCD patients with clinical -severity. However, its use in the pediatric groups remains atypical. Despite a high prevalence of the disease in the state Chhattisgarh, there is a lack of evidence supporting its use in pediatric patients. This study aimed to evaluate the pharmacological and clinical efficacy and safety of HU in a large pediatric cohort with SCD from Central India. The study cohort consisted of 164 SCD (138 Hb SS and 26 Hb S beta-thalassemia) children (≤14 years of age) on HU therapy, who were monitored for toxicity, hematological and clinical efficacy at baseline (Pre-HU) and after 24 months (Post-HU). The results highlight the beneficial effects of HU at a mean dose of 18.7 ± 7.0 mg/kg/day. A significant improvement was observed, not only in physical and clinical parameters but also in hematological parameters which include fetal hemoglobin (Hb F), total hemoglobin, hematocrit, mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) levels, when evaluated against the baseline. We did not observe any significant adverse effects during the treatment period. Similar results were obtained on independent analysis of Hb SS and Hb Sβ patients. These findings strengthen the beneficial effect of hydroxyurea in pediatric population also without any serious adverse effects and builds up ground for expanding its use under regular monitoring.
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Affiliation(s)
- Harsha Lad
- Chhattisgarh Institute of Medical Sciences (CIMS), Bilaspur, Chhattisgarh, India
| | - Shoma Naskar
- Genomic Research on Complex diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, Telangana, India
| | - S K D B Punyasri Pasupuleti
- Genomic Research on Complex diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, Telangana, India
| | - Rakesh Nahrel
- Chhattisgarh Institute of Medical Sciences (CIMS), Bilaspur, Chhattisgarh, India
| | - Pradeep Sihare
- Sihare Children's Hospital, Bilaspur, Chhattisgarh, India
| | - Giriraj R Chandak
- Genomic Research on Complex diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, Telangana, India
| | - Pradeep K Patra
- Chhattisgarh Institute of Medical Sciences (CIMS), Bilaspur, Chhattisgarh, India
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Dehury S, Mohanty PK, Patel S, Meher S, Das K, Purohit P, Sahoo S, Ratha J. Profiling of 35 Cases of Hb S/Hb E ( HBB: c.20A>T/ HBB: c.79G>a), Disease and Association with α-Thalassemia and β-Globin Gene Cluster Haplotypes from Odisha, India. Hemoglobin 2022; 45:380-386. [PMID: 35243949 DOI: 10.1080/03630269.2021.1965618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hb S/Hb E (HBB: c.20A>T/HBB: c.79G>A) is an uncommon variant of sickle cell disease resulting from coinheritance of Hb S and Hb E. Clinico-hematological and biochemical parameters of 35 cases of Hb S/Hb E disease were studied and compared with 70 matched cases of homozygous sickle cell disease (Hb SS) and Hb S/β-thalassemia (β-thal) with IVS-I-5 (G>C) (HBB: c.92+5G>C). The influence of α-thal and that of of β-globin gene cluster haplotypes among Hb S/Hb E disease was also studied. Statistical analysis was done using GraphPad InStat version 3.06. Of the 35 cases, 20 (57.14%) had a moderate clinical presentation. Mean lactate dehydrogenase (LDH) level, vaso-occlusive crises (VOCs) per year, and annual blood transfusion requirements were significantly lower in Hb S/Hb E cases than in the other two groups. The hemoglobin (Hb) and packed cell volume (PCV) levels were significantly high in Hb S/Hb E cases with α-thal and these cases were associated with microcytic-hypochromic anemia. α-Thalassemia did not influence clinical presentation in Hb S/Hb E cases. The β-globin gene cluster haplotypes of 70 alleles of Hb S/Hb E revealed an association of five typical haplotypes [Arab-Indian (A-I), Benin, Bantu, Cameroon and Senegal] in 95.71% cases. Hb S/Hb E disease exhibit asymptomatic to moderate phenotypic expression. However, further in-depth studies on Hb S/Hb E will help in reducing the disease burden especially in high-risk countries like India.
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Affiliation(s)
- Snehadhini Dehury
- Sickle Cell Institute, Sickle Cell Project (National Health Mission Odisha), Veer Surendra Sai Institute of Medical Science and Research (VIMSAR), Burla, Sambalpur, Odisha, India.,School of Life Sciences, Sambalpur University, Jyoti Vihar, Burla, Sambalpur, Odisha, India
| | - Pradeep K Mohanty
- Sickle Cell Institute, Sickle Cell Project (National Health Mission Odisha), Veer Surendra Sai Institute of Medical Science and Research (VIMSAR), Burla, Sambalpur, Odisha, India.,Department of Medicine, VIMSAR, Burla, Sambalpur, Odisha, India
| | - Siris Patel
- Sickle Cell Institute, Sickle Cell Project (National Health Mission Odisha), Veer Surendra Sai Institute of Medical Science and Research (VIMSAR), Burla, Sambalpur, Odisha, India
| | - Satyabrata Meher
- Sickle Cell Institute, Sickle Cell Project (National Health Mission Odisha), Veer Surendra Sai Institute of Medical Science and Research (VIMSAR), Burla, Sambalpur, Odisha, India
| | - Kishalaya Das
- Sickle Cell Institute, Sickle Cell Project (National Health Mission Odisha), Veer Surendra Sai Institute of Medical Science and Research (VIMSAR), Burla, Sambalpur, Odisha, India
| | - Prasanta Purohit
- Multi-Disciplinary Research Unit, Maharaja Krishna Chandra Gajapati (MKCG) Medical College, Berhampur, Odisha, India
| | - Sarmila Sahoo
- Sickle Cell Institute, Sickle Cell Project (National Health Mission Odisha), Veer Surendra Sai Institute of Medical Science and Research (VIMSAR), Burla, Sambalpur, Odisha, India
| | - Jagnyeswar Ratha
- School of Life Sciences, Sambalpur University, Jyoti Vihar, Burla, Sambalpur, Odisha, India
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Tripathi P, Agarwal S, Gupta A, Mandal K. Biallelic rare 17 bp deletion mutation (HBB:c.380_396 del TGCAGGCTGCCTATCAG) in a transfusion depended form of thalassemia. Ann Hematol 2020; 99:2719-2722. [DOI: 10.1007/s00277-020-04017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
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