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Rombout-Sestrienkova E, Winkens B, van Kraaij M, van Deursen CTBM, Janssen MCH, Rennings AMJ, Evers D, Kerkhoffs JL, Masclee A, Koek GH. A predictive model for estimating the number of erythrocytapheresis or phlebotomy treatments for patients with naïve hereditary hemochromatosis. J Clin Apher 2020; 36:340-347. [PMID: 33368569 PMCID: PMC8247321 DOI: 10.1002/jca.21867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 01/01/2023]
Abstract
Background and Aims Standard treatment for naïve hereditary hemochromatosis patients consists of phlebotomy or a personalized erythrocytapheresis. Erythrocytapheresis is more efficient, but infrequently used because of perceived costs and specialized equipment being needed. The main aim of our study was to develop a model that predicts the number of initial treatment procedures for both treatment methods. This information may help the clinician to select the optimal treatment modality for the individual patient. Methods We analyzed retrospective data of 125 newly diagnosed patients (C282Y homozygous), treated either with phlebotomy (n = 54) or erythrocytapheresis (n = 71) until serum ferritin (SF) reached levels ≤100 μg/L. To estimate the required number of treatment procedures multiple linear regression analysis was used for each treatment method separately. Results The linear regression model with the best predictive quality (R2 = 0.74 and 0.73 for erythrocytapheresis and phlebotomy respectively) included initial SF, initial hemoglobin (Hb) level, age, and BMI, where initial SF was independently related to the total number of treatment procedures for both treatment methods. The prediction error expressed in RMSPE and RMSDR was lower for erythrocytapheresis than for phlebotomy (3.8 and 4.1 vs 7.0 and 8.0 respectively), Conclusions Although the prediction error of the developed model was relatively large, the model may help the clinician to choose the most optimal treatment method for an individual patient. Generally erythrocytapheresis halves the number of treatment procedures for all patients, where the largest reduction (between 55% and 64%) is reached in patients with an initial Hb level ≥ 9 mmol/L (14.5 g/dL). ClinicalTrials.gov number NCT00202436.
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Affiliation(s)
- Eva Rombout-Sestrienkova
- Department of Transfusion Medicine, Sanquin Blood Supply, Blood Bank Division, Amsterdam, The Netherlands.,Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and statistics, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Marian van Kraaij
- Department of Transfusion Medicine, Sanquin Blood Supply, Blood Bank Division, Amsterdam, The Netherlands
| | | | - Mirian C H Janssen
- Department of General Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.,Department of Pediatrics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Alexander M J Rennings
- Department of General Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Dorothea Evers
- Department of Immuno-hematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
| | - Jean-Louis Kerkhoffs
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Hematology, HAGA Teaching Hospital, The Hague, The Netherlands
| | - Ad Masclee
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ger H Koek
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
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Rombout-Sestrienkova E, van Kraaij MGJ, Koek GH. How we manage patients with hereditary haemochromatosis. Br J Haematol 2016; 175:759-770. [PMID: 27723100 DOI: 10.1111/bjh.14376] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A number of disorders cause iron overload: some are of genetic origin, such as hereditary haemochromatosis, while others are acquired, for instance due to repeated transfusions. This article reviews the treatment options for hereditary haemochromatosis, with special attention to the use of erythrocytapheresis. In general, therapy is based on the removal of excess body iron, for which ferritin levels are used to monitor the effectiveness of treatment. For many decades phlebotomy has been widely accepted as the standard treatment. Recent publications suggest that erythrocytapheresis, as a more individualized treatment, can provide a good balance between effectiveness, tolerability and costs. Other treatments like oral chelators and proton pomp inhibitors, which are used in selected patients, create the possibility to further individualize treatment of hereditary haemochromatosis. In the future, hepcidin-targeted therapy could provide a more fundamental approach to treatment.
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Affiliation(s)
- Eva Rombout-Sestrienkova
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, the Netherlands
| | - Marian G J van Kraaij
- Department of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, the Netherlands
| | - Ger H Koek
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
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Verhaegh PLM, Moris W, Koek GH, van Deursen CTBM. The modified iron avidity index: a promising phenotypic predictor in HFE-related haemochromatosis. Liver Int 2016; 36:1535-9. [PMID: 26992127 DOI: 10.1111/liv.13121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 03/07/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Phenotypes of the HFE-related haemochromatosis vary considerably, making it hard to predict the course of iron accumulation. The aim of this retrospective study was to determine if the Iron Avidity Index (IAI) is a good phenotypic predictor of the number of phlebotomies needed per year during maintenance treatment (NPDMT) in patients with homozygous p.C282Y hereditary haemochromatosis (HH). METHODS Patients with HH homozygous for p.C282Y, on maintenance treatment for at least 1 year were included. The IAI (ferritin level at diagnosis/age at diagnosis) was calculated. RESULTS Ninety-five patients were included in the analysis. Linear regression analysis showed the confounding effect of sex on the relationship between IAI and NPDMT. A modified IAI, adjusted for sex, was calculated. As proton pump inhibitor (PPI) use was independently associated with NPDMT, the group was split in PPI- and non-PPI-users. A positive correlation between the modified IAI and the NPDMT was shown in both groups (PPI r = 0.367, P = 0.023; non-PPI r = 0.453, P < 0.001). An ROC was computed to measure the accuracy of the modified IAI to predict who needed 0-2 vs. ≥3 maintenance treatments per year. The AUROC in the PPI and non-PPI group were respectively 0.576 (0.368-0.784) and 0.752 (0.606-0.899). CONCLUSION The modified IAI is a fairly good predictor in non-PPI-using homozygous C282Y HH patients, to differentiate who needs ≥3 maintenance phlebotomies per year. Therefore, this index might help to select patients that benefit from an alternative less frequent therapy, e.g. erythrocytapheresis.
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Affiliation(s)
- Pauline L M Verhaegh
- Maastricht University Medical Center, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht, the Netherlands
| | - Wenke Moris
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Ger H Koek
- Maastricht University Medical Center, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht, the Netherlands
| | - Cees Th B M van Deursen
- Maastricht University Medical Center, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht, the Netherlands. .,Zuyderland Medical Center, Department of Internal Medicine, Gastroenterology and Geriatrics, Heerlen, the Netherlands.
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