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Ashok Kumar P, Ghimire K, Haroun E, Kassab J, Saba L, Gentile T, Dutta D, Lim SH. Utilization and outcome disparities in allogeneic hematopoietic stem cell transplant in the United States. Eur J Haematol 2024; 112:328-338. [PMID: 37899652 DOI: 10.1111/ejh.14129] [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: 09/29/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/31/2023]
Abstract
Allogeneic hematopoietic stem cell transplant (allo-HSCT) is increasingly being used in the United States (US) and across the world as a curative therapeutic option for patients with certain high-risk hematologic malignancies and non-malignant diseases. However, racial and ethnic disparities in utilization of the procedure and in outcome following transplant remain major problems. Racial and ethnic minority patients are consistently under-represented in the proportion of patients who undergo allo-HSCT in the US. The transplant outcomes in these patients are also inferior. The interrelated driving forces responsible for the differences in the utilization and transplant outcome of the medical intervention are socioeconomic status, complexity of the procedure, geographical barriers, and the results of differences in the genetics and comorbidities across different races. Bridging the disparity gaps is important not only to provide equity and inclusion in the utilization of this potentially life-saving procedure but also in ensuring that minority groups are well represented for research studies about allo-HSCT. This is required to determine interventions that may be more efficacious in particular racial and ethnic groups. Various strategies at the Federal, State, and Program levels have been designed to bridge the disparity gaps with varying successes. In this review paper, we will examine the disparities and discuss the strategies currently available to address the utilization and outcome gaps between patients of different races in the US.
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Affiliation(s)
- Prashanth Ashok Kumar
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Krishna Ghimire
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Elio Haroun
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Joseph Kassab
- Department of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Ludovic Saba
- Department of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Teresa Gentile
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Dibyendu Dutta
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Seah H Lim
- Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, New York, USA
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2
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Sharma A, Young A, Carroll Y, Darji H, Li Y, Mandrell B, Nelson MN, Owens CL, Irvine M, Caples M, Jerkins LP, Unguru Y, Hankins JS, Johnson LM. Gene therapy in sickle cell disease: Attitudes and informational needs of patients and caregivers. Pediatr Blood Cancer 2023; 70:e30319. [PMID: 36975201 PMCID: PMC10187715 DOI: 10.1002/pbc.30319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/23/2023] [Accepted: 03/05/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is an inherited blood disorder that results in serious morbidity and early mortality. Novel therapies for SCD, most notably genetic therapies (GTs) and HLA-mismatched donor hematopoietic cell transplantation, are in clinical trials. While potentially curative, these interventions are some of the most intensive treatments for SCD and are associated with serious and life-altering side effects, which may manifest several years after treatment. Little is known about knowledge, beliefs, and attitudes of individuals with SCD, or their caregivers, toward existing and these emerging therapies. METHODS Patients with SCD at least 13 years of age (n = 66) and caregivers (n = 38) were surveyed about knowledge, attitudes, and beliefs surrounding treatments for SCD. RESULTS Only 4.8% felt "extremely knowledgeable" about GT for SCD while the majority (63.4%) reported little knowledge. Overall, health literacy was low among respondents. Most respondents had a neutral attitude regarding the safety of GT for SCD, and whether it was a good treatment for the disorder (56.7% and 58.6%, respectively). Only a few respondents endorsed the idea that GT was "unsafe" or "not a good treatment" (5.8% and 4.8%, respectively). There was an association between increasing knowledge about GT and agreement that it is safe (p = .012) and a good treatment for SCD (p = .031). CONCLUSIONS Given that very few patients with SCD feel knowledgeable about GT and a majority have neutral feelings about the safety and utility of this new approach, culturally appropriate patient-centered education is urgently needed as these treatments get regulatory approval and proceed to the clinic.
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Affiliation(s)
- Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children’s Research Hospital
| | - Amanda Young
- Department of Communication and Film, University of Memphis
| | - Yvonne Carroll
- Department of Hematology, St. Jude Children’s Research Hospital
| | - Himani Darji
- Department of Biostatistics, St. Jude Children’s Research Hospital
| | - Yimei Li
- Department of Biostatistics, St. Jude Children’s Research Hospital
| | - Belinda Mandrell
- Division of Nursing Research, St. Jude Children’s Research Hospital
| | | | | | - Mary Irvine
- Hospitalist Program, St. Jude Children’s Research Hospital
| | - Mary Caples
- Division of Nursing Research, St. Jude Children’s Research Hospital
| | | | - Yoram Unguru
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children’s Hospital at Sinai
- Berman Institute of Bioethics, Johns Hopkins University
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital
| | - Liza-Marie Johnson
- Hospitalist Program, St. Jude Children’s Research Hospital
- Department of Oncology, St. Jude Children’s Research Hospital
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3
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Monagel DA, Alemam N, Betar M, Alnafisi FN, Faidah DE, Aloteibi RE, Khan M, Malli IA. The perception of pediatric sickle cell anemia patient's caregivers toward hematopoietic stem cell transplantation (single-center experience, Saudi Arabia). Front Pediatr 2023; 11:1205351. [PMID: 37287628 PMCID: PMC10242087 DOI: 10.3389/fped.2023.1205351] [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] [Received: 04/13/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023] Open
Abstract
Background Sickle cell disease (SCD) is a relatively common genetic disorder in Saudi Arabia characterized by the predominance of sickle hemoglobin (HbS). Although multiple supportive care options exist for patients with SCD, hematopoietic stem cell transplantation (HSCT) is the only cure available and has become highly successful, with an almost 91% overall survival rate. However, pursuing this procedure is still restrained as a curative treatment option. Therefore, this study aimed to evaluate the perception of parents' caregivers at the National Guard Hospital pediatric hematology clinic regarding using HSCT as a curative approach for their children with SCD. Methods This is a cross-sectional study of the interviewer-administered survey distributed utilizing electronic devices to caregivers of pediatric patients with SCD. Subjects were recruited from Pediatric Hematology & Oncology clinics at National Guard Hospital Affairs in King Abdulaziz Medical City, Jeddah, Saudi Arabia. An estimated sample size of 100 was initially calculated out of 140 pediatric SCD patients; 72 responses were collected from participants. All study participants gave informed consent. All results were analyzed using SPSS; moreover, statistics were set at a CI of 95% and a p < 0.05. In addition, inferential and descriptive statistics were done. Results Of all respondents, 42 (67.8%) would accept HSCT if their hematologist recommended it. However, approximately 7 (11.3%) were not interested in the procedure, and the rest, 13 (21%), were uncertain. The most reported reasons for HSCT rejection among all respondents were attributed to side effects 31 (50.8%), lack of knowledge 8 (13.1%), and misconception toward the procedure 22 (36.1%). Conclusion The results of this study were consistent with the fact that most caregivers would follow along with HSCT if it seemed to be fit and was recommended by their hematologists. However, to the best of our knowledge, our study being the first of its kind in the region, further research in the kingdom on the perception of HSCT is needed. Nonetheless, further patient education, an increase in caregivers' knowledge, and enlightenment of the medical team on HSCT as a curative option for sickle cell disease are vital.
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Affiliation(s)
- Dania A. Monagel
- College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Oncology, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Naglla Alemam
- Department of Oncology, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Manar Betar
- College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Fay N. Alnafisi
- College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Dania E. Faidah
- College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Reema E. Aloteibi
- College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Muhammad Khan
- College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Israa A. Malli
- College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
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Watson D, Mhlaba M, Molelekeng G, Chauke TA, Simao SC, Jenner S, Ware LJ, Barker M. How do we best engage young people in decision-making about their health? A scoping review of deliberative priority setting methods. Int J Equity Health 2023; 22:17. [PMID: 36698119 PMCID: PMC9876416 DOI: 10.1186/s12939-022-01794-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/18/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION International organisations have called to increase young people's involvement in healthcare and health policy development. We currently lack effective methods for facilitating meaningful engagement by young people in health-related decision-making. The purpose of this scoping review is to identify deliberative priority setting methods and explore the effectiveness of these in engaging young people in healthcare and health policy decision-making. METHODS Seven databases were searched systematically, using MeSH and free text terms, for articles published in English before July 2021 that described the use of deliberative priority setting methods for health decision-making with young people. All titles, abstracts and full-text papers were screened by a team of six independent reviewers between them. Data extraction followed the Centre for Reviews and Dissemination guidelines. The results are presented as a narrative synthesis, structured around four components for evaluating deliberative processes: 1) representation and inclusion of diverse participants, 2) the way the process is run including levels and timing of participant engagement, 3) the quality of the information provided to participants and 4) resulting outcomes and decisions. FINDINGS The search yielded 9 reviews and 21 studies. The more engaging deliberative priority setting tools involved young people-led committees, mixed methods for identifying and prioritising issues and digital data collection and communication tools. Long-term and frequent contact with young people to build trust underpinned the success of some of the tools, as did offering incentives for taking part and skills development using creative methods. The review also suggests that successful priority setting processes with young people involve consideration of power dynamics, since young people's decisions are likely to be made together with family members, health professionals and academics. DISCUSSION Young people's engagement in decision-making about their health is best achieved through investing time in building strong relationships and ensuring young people are appropriately rewarded for their time and contribution. If young people are to be instrumental in improving their health and architects of their own futures, decision-making processes need to respect young people's autonomy and agency. Our review suggests that methods of power-sharing with young people do exist but that they have yet to be adopted by organisations and global institutions setting global health policy.
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Affiliation(s)
- Daniella Watson
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK. .,SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa. .,Department of Global Health and Social Medicine, King's College London, London, UK.
| | - Mimi Mhlaba
- grid.11951.3d0000 0004 1937 1135SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Gontse Molelekeng
- grid.11951.3d0000 0004 1937 1135SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Thulani Andrew Chauke
- grid.412801.e0000 0004 0610 3238Department of Adult, College of Education, Community and Continuing Education, University of South Africa, Pretoria, South Africa
| | - Sara Correia Simao
- grid.5491.90000 0004 1936 9297Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Sarah Jenner
- grid.5491.90000 0004 1936 9297Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Lisa J. Ware
- grid.11951.3d0000 0004 1937 1135SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa ,grid.11951.3d0000 0004 1937 1135DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Barker
- grid.5491.90000 0004 1936 9297Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK ,grid.5491.90000 0004 1936 9297School of Health Sciences, Faculty of Life and Environmental Sciences, University of Southampton, Southampton, UK ,grid.11951.3d0000 0004 1937 1135School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ,grid.430506.40000 0004 0465 4079NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
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5
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Byrnes C, Botello-Harbaum M, Clemons T, Bailey L, Valdes K, Coleman-Cowger V. Process and strategies for patient engagement and outreach in the Sickle Cell Disease (SCD) community to promote clinical trial participation. J Natl Med Assoc 2022; 114:211-217. [PMID: 35093266 PMCID: PMC9058174 DOI: 10.1016/j.jnma.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) is the most common inherited blood disorder in the United States. The Cure Sickle Cell Initiative (CureSCi) was created by the National Heart, Lung and Blood Institute (NHLBI) to improve the lives of people with SCD by accelerating the advancement of safe and promising genetic therapies, engaging the SCD community and healthcare providers, and encouraging collaboration among stakeholders. CureSCi is a collaborative, patient-focused research effort that includes patients at every level of the Initiative. Patient engagement is a key component, particularly during the development of clinical trials. OBJECTIVE To describe the processes and strategies utilized by the CureSCi to engage individuals living with SCD about genetic therapy clinical trials. METHODS The CureSCi Patient Engagement team conducted nine Community Outreach visits in 2019, each of which was structured to include separate group interviews with patients and medical providers. A set of guidance questions was developed for each audience and the interviews lasted approximately 60 minutes. RESULTS Patients were asked about their participation in a clinical trial, and approximately 50% had participated in a trial. SCD individuals reported trusting their medical provider to provide them with information relevant to trials. Medical providers emphasized the individual, family, and health aspects of SCD that warrant additional investigation. Providers reported barriers encountered by patients as transportation, childcare support, infertility, and trust in the healthcare system. CONCLUSION Lessons learned from the community have helped to influence recommendations for clinical trial design and key messaging development for the Cure Sickle Cell Initiative.
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6
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Landry I. Racial disparities in hematopoietic stem cell transplant: a systematic review of the literature. Stem Cell Investig 2021; 8:24. [PMID: 35071585 PMCID: PMC8743384 DOI: 10.21037/sci-2021-058] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplant (HSCT) is an expensive and complex treatment regimen that can be curative in many diseases of the bone marrow, including malignant and non-malignant conditions. The introduction of the Affordable Care Act increased access to potential candidates and removed or reduced many barriers previously identified in the literature, however, racial disparities continue to persist. As HSCT expands its utilization and indications, there is a continued need to understand the multifactorial barriers which lead to inequalities in transplant referral, utilization, and survival. The objective of this systematic review is to summarize these racial disparities, expand the current understanding of the literature, and determine whether the increases in insurance status from Medicaid expansion have played a role in HSCT utilization and survival rates by race. METHODS We explored studies based on retrospective reviews, literature reviews, and focus groups with the key-terms of 'race', 'hematopoietic stem cell transplant', and 'disparities'. The included studies were extracted from Cochrane and Medline databases. After screening for relevancy to research aims and objectives, 10 articles were utilized for background information and discussion, while 30 articles were categorized into main groups of outcomes, chiefly, (I) access/referral to transplant and (II) survival. RESULTS Eight of the eleven retrospective reviews found substantial variation in access to HSCT by ethnic minorities (Black, Hispanic, or Asian) when compared to their Caucasian counterparts. Thirteen of the fourteen publications found racial disparities in either overall survival, progression free survival, treatment related mortality, relapse, or combinations of these outcomes. The majority of the studies evaluated African American patients with six of eight studies showing significantly elevated mortality compared to Caucasian patients. DISCUSSION Substantial variation exists in access to HSCT, particularly in black patients. Having less generous insurance coverage was previously hypothesized to reduce the likelihood of HSCT utilization. Studies performed after full implementation of the Affordable Care Act continue to show poorer survival among ethnic minorities, particularly black patients, despite this increased coverage. Perceived racial bias and health-related stigma, as well as physician decisions and delay in referral process are likely contributing factors.
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Affiliation(s)
- Ian Landry
- Internal Medicine, Icahn School of Medicine at Mt Sinai, Queens Hospital Center, Jamaica, Queens, NY, USA
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7
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Salcedo J, Bulovic J, Young CM. Cost-effectiveness of a hypothetical cell or gene therapy cure for sickle cell disease. Sci Rep 2021; 11:10838. [PMID: 34035408 PMCID: PMC8149675 DOI: 10.1038/s41598-021-90405-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/11/2021] [Indexed: 12/21/2022] Open
Abstract
Sickle cell disease (SCD) is a group of inherited genetic conditions associated with lifelong complications and increased healthcare resource utilization. Standard treatment for SCD in the US varies based on stage of the disease and observed clinical severity. In this study, we aim to evaluate the potential cost-effectiveness of a durable cell or gene therapy cure for sickle cell disease from the US healthcare sector perspective. We developed a lifetime Markov model to evaluate the cost-effectiveness of a hypothetical single-administration durable treatment (DT) for SCD provided at birth, relative to standard of care (SOC). We informed model inputs including direct healthcare costs, health state utility weights, transition probabilities, and mortality rates using a retrospective database analysis of commercially insured individuals and the medical literature. Our primary outcome of interest was the incremental cost-effectiveness ratio (ICER) of DT versus SOC evaluated at a base case willingness-to-pay (WTP) threshold of $150,000 per quality-adjusted life year (QALY). We tested the robustness of our base case findings through scenario, deterministic sensitivity (DSA), and probabilistic sensitivity analyses (PSA). In the base case analysis, treatment with DT was cost-effective with an ICER of $140,877/QALY relative to SOC for a hypothetical cohort involving 47% females. Both males (ICER of $135,574/QALY) and females (ICER of $146,511/QALY) were similarly cost-effective to treat. In univariate DSA the base case ICER was most sensitive to the costs of treating males, DT treatment cost, and the discount rate. In PSA, DT was cost-effective in 32.7%, 66.0%, and 92.6% of 10,000 simulations at WTP values of $100,000, $150,000, and $200,000 per QALY, respectively. A scenario analysis showed cost-effectiveness of DT is highly contingent on assumed lifetime durability of the cure. A hypothetical cell or gene therapy cure for SCD is likely to be cost-effective from the US healthcare sector perspective. Large upfront costs of a single administration cure are offset by significant downstream gains in health for patients treated early in life. We find cost-effectiveness outcomes do not vary substantially by gender; however, several model parameters including assumed durability and upfront cost of DT are likely to influence cost-effectiveness findings.
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Affiliation(s)
- Jonathan Salcedo
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, 635 Downey Way, Verna & Peter Dauterive Hall, VPD 312, Los Angeles, CA, 90089-3333, USA. .,Center for Biomedical Innovation, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Jenniffer Bulovic
- Center for Biomedical Innovation, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Colin M Young
- Center for Biomedical Innovation, Massachusetts Institute of Technology, Cambridge, MA, USA
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8
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Kogel F, Hakimeh D, Sodani P, Lang P, Kühl JS, Hundsdoerfer P, Künkele A, Eggert A, Oevermann L, Schulte JH. Allogeneic hematopoietic stem cell transplantation from sibling and unrelated donors in pediatric patients with sickle cell disease-A single center experience. Pediatr Transplant 2021; 25:e13892. [PMID: 33098344 DOI: 10.1111/petr.13892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/21/2020] [Accepted: 09/27/2020] [Indexed: 11/27/2022]
Abstract
HSCT is curative in SCD. Patients with HLA-identical sibling donor have an excellent outcome ranging from 90%-100% overall and event-free survival. However, due to the lack of matched sibling donors this option is out of reach for 70% of patients with SCD. The pool of potential donors needs to be extended. Transplantations from HLA-matched unrelated donors were reported to be less successful with shorter event-free survival and higher incidences of complications including graft-vs-host disease, especially in patients with advanced stage SCD. Here we report transplantation outcomes for 25 children with SCD transplanted using HLA-matched grafts from related or unrelated donors. Overall survival was 100% with no severe (grade III-IV) graft-vs-host disease and a 12% rejection rate. Mixed donor chimerisms only occurred in transplantations from siblings, while transplantations from unrelated donors resulted in either complete donor chimerism or rejection. Despite the small patient number, overall and disease-free survival for unrelated donor transplantations is excellent in this cohort. The advanced disease state, higher alloreactive effect and stronger immunosuppression in unrelated donor transplantations raises patient risk, for which possible solutions could be found in optimization of transplant preparation, graft manipulation or haploidentical transplantation using T cell receptor α/β-depleted grafts.
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Affiliation(s)
- Friederike Kogel
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dani Hakimeh
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pietro Sodani
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Lang
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Pediatric Hematology and Oncology, University Hospital, Tübingen, Germany
| | - Jörn-Sven Kühl
- Department of Pediatric Oncology, Hematology, and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Patrick Hundsdoerfer
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Department of Pediatrics, Helios-Klinikum Berlin-Buch, Berlin, Germany
| | - Annette Künkele
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berliner Institut für Gesundheitsforschung (BIH), Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Angelika Eggert
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berliner Institut für Gesundheitsforschung (BIH), Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Oevermann
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berliner Institut für Gesundheitsforschung (BIH), Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Johannes H Schulte
- Department of Pediatric Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berliner Institut für Gesundheitsforschung (BIH), Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
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9
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Mahesri M, Schneeweiss S, Globe D, Mutebi A, Bohn R, Achebe M, Levin R, Desai RJ. Clinical outcomes following bone marrow transplantation in patients with sickle cell disease: A cohort study of US Medicaid enrollees. Eur J Haematol 2020; 106:273-280. [PMID: 33155319 DOI: 10.1111/ejh.13546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Bone marrow transplantation (BMT) is currently the only curative therapy available for patients with sickle cell disease (SCD), but clinical outcomes in routine care are not well understood. We describe the rates of vaso-occlusive crises (VOCs), transplant complications, and mortality in SCD patients after BMT. METHODS A cohort study of SCD patients who underwent BMT was designed using US Medicaid claims data (2000-2013). RESULTS A total of 204 SCD patients undergoing BMT were identified with a mean (SD) age of 10.6 (7.3) years, with 52.9% male and 67.6% African American. The overall VOC rate was 0.99 per person-year (95% CI: 0.91-1.07) over a median follow-up time of 2.1 years (IQR: 0.8-4.3 years). A total of 138 (67.6%) remained free of VOCs. The mortality rate was 1.7 (95% CI: 0.9-3.1) per 100 person-years, transplant-related complications occurred among 113 (55.4%) patients with an incidence rate of 38.2 (95% CI: 31.7-45.9) per 100 person-years, while 47 (23%) patients had GvHD with an incidence rate of 8.0 (95% CI: 6.0-10.7) per 100 person-years. CONCLUSION Two thirds of the BMT recipients remained VOC-free over 2 years of follow-up, but transplant-related complications, including GvHD occurred with high frequency. This highlights a continuing unmet need for alternative curative interventions in SCD.
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Affiliation(s)
- Mufaddal Mahesri
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
| | | | - Alex Mutebi
- Vertex Pharmaceuticals Inc., Boston, MA, USA
| | | | - Maureen Achebe
- Hematology Division, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - Raisa Levin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
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10
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Masese RV, DeMartino T, Bonnabeau E, Burns EN, Preiss L, Varughese T, Nocek JM, Lasley P, Chen Y, Davila C, Nwosu C, Scott S, Bowman L, Gordon L, Clesca C, Peters-Lawrence M, Melvin C, Shah N, Tanabe P. Effective Recruitment Strategies for a Sickle Cell Patient Registry Across Sites from the Sickle Cell Disease Implementation Consortium (SCDIC). J Immigr Minor Health 2020; 23:725-732. [PMID: 33034793 PMCID: PMC8032811 DOI: 10.1007/s10903-020-01102-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 10/27/2022]
Abstract
Sickle cell disease (SCD) is a genetic disorder predominantly affecting people of African descent and is associated with significant morbidity and mortality. To improve SCD outcomes, the National Heart Lung and Blood Institute funded eight centers to participate in the SCD Implementation Consortium. Sites were required to each recruit 300 individuals with SCD, over 20 months. We aim to describe recruitment strategies and challenges encountered. Participants aged 15-45 years with confirmed diagnosis of SCD were eligible. Descriptive statistics were used to analyze the effectiveness of each recruitment strategy. A total of 2432 participants were recruited. Majority (95.3%) were African American. Successful strategies were recruitment from clinics (68.1%) and affiliated sites (15.6%). Recruitment at community events, emergency departments and pain centers had the lowest yield. Challenges included saturation of strategies and time constraints. Effective recruitment of participants in multi-site studies requires multiple strategies to achieve adequate sample sizes.
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Affiliation(s)
- Rita V Masese
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA.
| | - Terri DeMartino
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | - Emily Bonnabeau
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | - Ebony N Burns
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | | | - Taniya Varughese
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Judith M Nocek
- Department of Medicine, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Yumei Chen
- University of California, San Francisco, Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA
| | | | | | - Samantha Scott
- Augusta University Center for Blood Disorders, Augusta, GA, USA
| | - Latanya Bowman
- Augusta University Center for Blood Disorders, Augusta, GA, USA
| | - Lauren Gordon
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Cindy Clesca
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marlene Peters-Lawrence
- Division of Blood Diseases and Resources, National Institute of Health, National Heart Lung and Blood Institute, Bethesda, MD, USA
| | - Cathy Melvin
- Medical University of South Carolina, Charleston, SC, USA
| | - Nirmish Shah
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | - Paula Tanabe
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
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11
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Bakshi N, Katoch D, Sinha CB, Ross D, Quarmyne MO, Loewenstein G, Krishnamurti L. Assessment of Patient and Caregiver Attitudes and Approaches to Decision-Making Regarding Bone Marrow Transplant for Sickle Cell Disease: A Qualitative Study. JAMA Netw Open 2020; 3:e206742. [PMID: 32469414 PMCID: PMC7260617 DOI: 10.1001/jamanetworkopen.2020.6742] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Bone marrow transplant (BMT) is a potentially curative treatment for sickle cell disease (SCD). Patient and caregiver attitudes toward BMT for SCD and the willingness to accept risks of BMT vary, but these attitudes are not well understood. OBJECTIVE To understand patient and caregiver perceptions of and attitudes toward BMT for SCD and decision-making about BMT. DESIGN, SETTING, AND PARTICIPANTS Qualitative study of interview transcripts from a convenience sample. Transcripts were from adults with SCD and caregivers of patients with SCD recruited from national and regional SCD conferences, symposia, and sickle cell clinics in 2 cities. Interview transcripts were used from the needs assessment phase to develop a patient-decision aid in 2013 to 2014 (group 1) and from the baseline point in 2015 to 2016 (group 2) of the parent trial, a randomized clinical trial of adults and caregivers of patients with SCD to evaluate the effectiveness of a patient decision aid. MAIN OUTCOMES AND MEASURES Participant perspectives on decision-making regarding BMT for SCD. RESULTS Fifty-seven transcripts from adults with SCD and 50 transcripts from caregivers of patients with SCD were included. Median (interquartile range [IQR]) age of adults with SCD was 34 (21-50) years in group 1 and 30 (23-38) years in group 2. The median (IQR) age of caregivers was 42.5 (31-52) years in group 1 and 41 (35-46.5) years in group 2. Most transcripts from adults with SCD (75.0% in group 1 and 72.4% in group 2) and caregivers of patients with SCD (76.7% in group 1 and 85.0% in group 2) were from female participants. Bone marrow transplant was perceived as a treatment option associated with serious risks. Reported attitudes toward BMT occurred on a continuum ranging from unfavorable to favorable. Participants reported serious decisional dilemma regarding BMT for SCD. Most participants expressed interest in learning about BMT or curative treatments. CONCLUSIONS AND RELEVANCE This qualitative study found a continuum in attitudes toward BMT for SCD and highlights the complexity of decision-making in BMT for SCD. Patients and families with SCD expressed an interest in learning about BMT. Future prospective studies of patient decision-making regarding BMT, especially in the context of emerging curative and novel disease-modifying therapies for SCD, are warranted.
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Affiliation(s)
- Nitya Bakshi
- Department of Pediatrics, Division of Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Deeksha Katoch
- Department of Pediatrics, Division of Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Cynthia B. Sinha
- Department of Pediatrics, Division of Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, Georgia
| | - Diana Ross
- Department of Pediatrics, Division of Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, Georgia
| | - Maa-Ohui Quarmyne
- Department of Pediatrics, Division of Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - George Loewenstein
- Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Lakshmanan Krishnamurti
- Department of Pediatrics, Division of Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta, Atlanta, Georgia
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12
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Parent and Guardian Knowledge of Hematopoietic Cell Transplantation as a Treatment Option for Sickle Cell Disease. J Pediatr Hematol Oncol 2019; 41:187-193. [PMID: 30789459 DOI: 10.1097/mph.0000000000001433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Beginning early in childhood, patients with sickle cell disease (SCD) are at risk of life-threatening and debilitating health events. Despite the high morbidity and mortality of this disease, hematopoietic cell transplantation (HCT), a curative treatment for SCD, remains underutilized. In the literature there is a paucity of data concerning medical decision maker (MDM) awareness of HCT as a treatment option for SCD. The objective of this study was to estimate the proportion of parents/guardians of children with SCD who are aware of HCT as a treatment option, and to identify the demographic factors associated with knowledge of this therapy's curative potential. Between November 2015 and December 2016, 327 parents/guardians were surveyed across 4 clinical sites in 3 Midwestern US cities. Although 82% of parents/guardians had heard of HCT in the past and 78% were aware of the therapy's curative potential, nearly half indicated that they did not know whether HCT could specifically cure their child of the disease. Respondents who had discussed HCT with their child's physician had 5 times higher odds of being aware of HCT's curative potential than those who had not. These findings suggest that additional efforts to enhance MDM knowledge of HCT as well as shared decision making in the use of this therapy, is warranted.
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13
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Hulbert ML, Shenoy S. Hematopoietic stem cell transplantation for sickle cell disease: Progress and challenges. Pediatr Blood Cancer 2018; 65:e27263. [PMID: 29797658 DOI: 10.1002/pbc.27263] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 02/06/2023]
Abstract
Sickle cell disease (SCD) presents challenges to hematopoietic stem cell transplantation (HSCT), including donor availability and morbidity with age/disease severity. However, severe SCD causes irreversible organ damage that HSCT can mitigate. This benefit must be balanced against preparative regimen toxicity, graft-versus-host disease, and mortality risk. We review efforts to balance HSCT complications with the promise of cure, and knowledge gaps that warrant further investigation. We highlight the burden of SCD, HSCT risks and benefits, and SCD families' approach to this balance. We emphasize the necessity for information exchange to ensure a joint decision-making process between providers and patients.
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Affiliation(s)
- Monica L Hulbert
- Division of Pediatric Hematology/Oncology, Washington University in St. Louis, St. Louis, Missouri
| | - Shalini Shenoy
- Division of Pediatric Hematology/Oncology, Washington University in St. Louis, St. Louis, Missouri
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14
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Schulz GL, Kelly KP, Holtmann M, Doering MM, Armer JM. Decision making in pediatric hematopoietic cell transplantation: Influential factors vary among diseases. Pediatr Blood Cancer 2018; 65. [PMID: 29218777 DOI: 10.1002/pbc.26890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 12/31/2022]
Abstract
Hematopoietic cell transplantation (HCT) is not a trivial treatment decision in pediatrics. We sought to understand what influences this decision-making process from the perspectives of the pediatric patients, their family, and physicians. Using integrative review methods, we identified 19 relevant studies: six qualitative, ten quantitative, and three mixed methods. Synthesis of the results revealed six themes describing patient, family, and provider decision-making processes with distinct subthemes contrasting influential factors among malignant and nonmalignant diseases. Identification of what influences HCT decision making will aid in development of decision support, education, and communication strategies. The child/adolescent voice and provider perspective warrant more attention.
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Affiliation(s)
- Ginny L Schulz
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri.,Siteman Kids at St, Louis Children's Hospital, St. Louis, Missouri.,Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Katherine P Kelly
- Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Megan Holtmann
- Siteman Kids at St, Louis Children's Hospital, St. Louis, Missouri
| | - Michelle M Doering
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jane M Armer
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri.,American Lymphedema Framework Project, Columbia, Missouri
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15
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Haywood C, Lanzkron S, Diener-West M, Haythornthwaite J, Strouse JJ, Bediako S, Onojobi G, Beach MC. Attitudes toward clinical trials among patients with sickle cell disease. Clin Trials 2018; 11:275-283. [PMID: 24532686 DOI: 10.1177/1740774513519876] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background A substantial number of planned clinical trials for sickle cell disease (SCD) have terminated early due to insufficient patient enrollment. Purpose To describe attitudes toward clinical trials among a sample of adults with SCD and identify patient-level factors associated with these attitudes. Methods Our data came from a sample (N = 291) of primarily adults with SCD participating in the Improving Patient Outcomes with Respect and Trust (IMPORT) study, which is a federally funded observational study of SCD patient experiences in seeking healthcare. Attitudes toward clinical trials were assessed using items from the Perceptions of Participation in Clinical Research instrument. Patient factors examined as potential correlates of clinical trial attitudes were demographics, disease severity, engagement in self-care, trust, healthcare experience ratings, and prior history of participation in clinical trials. Multiple regression analyses were used to identify patient-level correlates of clinical trial attitudes. Results Our sample of SCD patients expressed overwhelmingly favorable attitudes about clinical trials, with 77%-92% of our sample expressing agreement with a series of positive statements about clinical trials in general. Demographics, engagement in self-care, healthcare experience ratings, and prior trial participation each explained significant portions of the variability in clinical trial attitudes. Limitations The generalizability of our results to the entire SCD population may be of concern as the study participants were all receiving care at comprehensive sickle cell centers and already participating in clinical research. Conclusion Our results suggest that, in principle, adults with SCD enrolled in an observational study express very positive general attitudes about clinical trial participation and that specific factors attached to particular clinical trial opportunities may play a greater role in a SCD patient's decision to participate than a general unwillingness to participate.
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Affiliation(s)
- Carlton Haywood
- a Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sophie Lanzkron
- a Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Marie Diener-West
- b Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | | | - John J Strouse
- d Department of Pediatrics, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shawn Bediako
- e Department of Psychology, The University of Maryland Baltimore County, Baltimore MD, USA
| | - Gladys Onojobi
- f Department of Medicine, The Howard University Hospital, Washington, DC, USA
| | - Mary Catherine Beach
- a Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA
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16
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Analysis of Common Eligibility Criteria of Randomized Controlled Trials in Newly Diagnosed Multiple Myeloma Patients and Extrapolating Outcomes. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:575-583.e2. [PMID: 28886839 DOI: 10.1016/j.clml.2017.06.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/08/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND The performance of multiple myeloma (MM) therapies in a general patient population and specific eligibility criteria that might limit enrollment into randomized controlled trials (RCTs) have not been evaluated in depth. This study aimed to determine if improvements seen with MM therapies in RCTs are reflected in the general patient population and to identify eligibility criteria that can be modified to increase enrollment. PATIENTS AND METHODS The Connect MM Registry is a prospective observational cohort study of patients with newly diagnosed MM (NDMM) in the United States. Using common RCT exclusion criteria collected from 16 published studies, patients in the registry were categorized according to their eligibility for inclusion in RCTs. RESULTS On the basis of common criteria, 563 of 1406 of registry patients (40.0%) are ineligible for RCTs. Criteria leading to exclusion included M-protein ≤ 1.0 g/dL (25.2%), creatinine > 2.5 mg/dL (13.9%), low absolute neutrophil count (10.0%), and low hemoglobin (9.6%). Significantly more RCT-ineligible versus RCT-eligible patients had hypercalcemia (11.0% vs. 5.5%), elevated creatinine levels (38.9% vs. 6.2%), low hemoglobin levels (59.5% vs. 39.5%), or International Staging System stage III disease (40.1% vs. 22.1%; P < .001 for all comparisons). RCT-ineligible patients had a lower 3-year survival rate than RCT-eligible patients (63% vs. 70%). The incidence of serious adverse events was similar between groups. CONCLUSION Of patients with NDMM enrolled in the Connect MM Registry, 40% are ineligible for RCTs. This study provides insight into potential modifications of standard eligibility criteria that can lead to improved RCT design and accelerated enrollment.
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17
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Graves D, Sheldon JP. Recruiting African American Children for Research: An Ecological Systems Theory Approach. West J Nurs Res 2017; 40:1489-1521. [PMID: 28436265 DOI: 10.1177/0193945917704856] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
With health disparities still pervasive and persistent in the United States, medical researchers and social scientists continue to develop recruitment strategies to increase the inclusion of racial/ethnic minority groups in research and interventions. Effective methods for recruiting samples of African American participants for pediatric research may be best understood when situated within an overarching conceptual model-one that serves to organize and explain effective recruitment strategies. A theoretical framework well suited for this purpose is Bronfenbrenner's ecological systems theory, which views individuals as influencing and being influenced by (both directly and indirectly) a series of interconnected social systems. Based on the ecological systems theory and on previous research from multiple domains (e.g., medicine, psychology, public health, social work), in the current article, we review strategies for effective recruitment of African American children and adolescents for research.
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18
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Byrne M, Danielson N, Harris A, Savani BN. Making inroads to the cure: Barriers to clinical trial enrollment in hematopoietic cell transplantation. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.12948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Byrne
- Vanderbilt University Medical Center; Nashville TN USA
| | | | - Amanda Harris
- Vanderbilt University Medical Center; Nashville TN USA
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19
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Bernaudin F, Pondarré C, Galambrun C, Thuret I. Allogeneic/Matched Related Transplantation for β-Thalassemia and Sickle Cell Anemia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1013:89-122. [DOI: 10.1007/978-1-4939-7299-9_4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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20
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Stevens EM, Patterson CA, Li YB, Smith-Whitley K, Barakat LP. Mistrust of Pediatric Sickle Cell Disease Clinical Trials Research. Am J Prev Med 2016; 51:S78-86. [PMID: 27320470 PMCID: PMC4916926 DOI: 10.1016/j.amepre.2016.01.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/13/2016] [Accepted: 01/27/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) research is hampered by disparities in participation due in part to mistrust of research among racial/ethnic minorities. Beyond the historic context of research misconduct, little is known about the associations of social ecologic factors with mistrust and of mistrust with SCD clinical trials enrollment. This study evaluated proximal (age, gender, disease severity, perceived stress, SES) and distal (religious beliefs, social support, instrumental support) factors related to mistrust of research among caregivers of children with SCD and adolescents and young adults (AYAs) with SCD. METHODS Over an 18-month period (2009-2010), participants completed questionnaires of perceived barriers and benefits to clinical trials enrollment, perceived stress, and self-reported demographic and disease-related information. Analyses (January-June 2015) used multivariable linear regressions to evaluate predictors of mistrust. RESULTS Data were analyzed for 154 caregivers (mean age, 38.75 years; SD=9.56 years; 90.30% female) and 88 AYAs (mean age, 24.76 years; SD=7.25 years; 46.40% female). Among caregivers (full model, R(2)=0.14, p≤0.001), greater mistrust was explained by higher perceived stress (β=0.04, p=0.052); religious beliefs (β=0.61, p≤0.001); and greater instrumental support (β=0.07, p=0.044). Among AYAs (full model, R(2)=0.18, p≤0.001), higher mistrust was explained by being male (β=-0.56, p≤0.001) and lower instrumental support (β=-0.11, p=0.016). Mistrust was significantly greater among caregivers that reported no prior involvement in medical research (p=0.003). CONCLUSIONS By understanding the complexity through which social ecologic factors contribute to mistrust, researchers may create targeted strategies to address mistrust and increase engagement in SCD research for caregivers and AYAs.
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Affiliation(s)
- Evelyn M Stevens
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;.
| | - Chavis A Patterson
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;; Perelman School of Medicine of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yimei B Li
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;; Perelman School of Medicine of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kim Smith-Whitley
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;; Perelman School of Medicine of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lamia P Barakat
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;; Perelman School of Medicine of The University of Pennsylvania, Philadelphia, Pennsylvania
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21
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Walters MC, De Castro LM, Sullivan KM, Krishnamurti L, Kamani N, Bredeson C, Neuberg D, Hassell KL, Farnia S, Campbell A, Petersdorf E. Indications and Results of HLA-Identical Sibling Hematopoietic Cell Transplantation for Sickle Cell Disease. Biol Blood Marrow Transplant 2016; 22:207-211. [PMID: 26500093 PMCID: PMC5031360 DOI: 10.1016/j.bbmt.2015.10.017] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 10/16/2015] [Indexed: 01/26/2023]
Abstract
Although a number of published trials exist of HLA-identical sibling hematopoietic cell transplantation (HCT) for sickle cell disease (SCD) that span 2 decades, when and for whom this therapy should be pursued is a subject of debate. Assessments of the risks of transplant-related complications that include infertility and debilitating graft-versus-host disease and long-term quality of life after successful HCT are difficult to perform without prospective trials in transplant and nontransplant cohorts. However, it is possible to assess the risk of mortality and to compare published rates of survival in individuals with SCD treated and not treated by HCT. In this brief review, projections about mortality risk based on recent published reports are reviewed and summarized. The published data show overall survival and event-free survival rates of 95% and 92%, respectively, in children treated by HLA-identical sibling HCT. The overall survival rates in the Center for International Blood and Marrow Transplant Research (N = 412) and European Blood and Marrow Transplant (N = 487) registries were 91% and 95%, respectively. These results provide broad support for the therapeutic value of HLA-identical sibling HCT for children with SCD and serve as the basis for a strong recommendation in favor of the option of HCT when a suitable donor is available. The experience of HLA-identical sibling HCT in adults with SCD is limited but appears to be similar to results in children. These preliminary observations, however, warrant further investigation.
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Affiliation(s)
- Mark C Walters
- Blood and Marrow Transplant Program, University of California (San Francisco) Benioff Children's Hospital, Oakland, California.
| | - Laura M De Castro
- Division of Hematology and Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Keith M Sullivan
- Blood and Marrow Transplant Program, Duke University Medical Center, Durham, North Carolina
| | - Lakshmanan Krishnamurti
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Naynesh Kamani
- Center for Cellular Therapies and Research, AABB, Bethesda, Maryland
| | - Christopher Bredeson
- Blood and Marrow Transplant Program, Ottawa Hospital Research Institute at University of Ottawa, Ottawa, Ontario, Canada
| | - Donna Neuberg
- Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Andrew Campbell
- Division of Pediatric Hematology/Oncology, University of Michigan, School of Medicine, Department of Pediatrics, Blood and Marrow Transplant Program, Ann Arbor, Michigan
| | - Effie Petersdorf
- Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine, Seattle, Washington
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22
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Angelucci E, Matthes-Martin S, Baronciani D, Bernaudin F, Bonanomi S, Cappellini MD, Dalle JH, Di Bartolomeo P, de Heredia CD, Dickerhoff R, Giardini C, Gluckman E, Hussein AA, Kamani N, Minkov M, Locatelli F, Rocha V, Sedlacek P, Smiers F, Thuret I, Yaniv I, Cavazzana M, Peters C. Hematopoietic stem cell transplantation in thalassemia major and sickle cell disease: indications and management recommendations from an international expert panel. Haematologica 2015; 99:811-20. [PMID: 24790059 DOI: 10.3324/haematol.2013.099747] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Thalassemia major and sickle cell disease are the two most widely disseminated hereditary hemoglobinopathies in the world. The outlook for affected individuals has improved in recent years due to advances in medical management in the prevention and treatment of complications. However, hematopoietic stem cell transplantation is still the only available curative option. The use of hematopoietic stem cell transplantation has been increasing, and outcomes today have substantially improved compared with the past three decades. Current experience world-wide is that more than 90% of patients now survive hematopoietic stem cell transplantation and disease-free survival is around 80%. However, only a few controlled trials have been reported, and decisions on patient selection for hematopoietic stem cell transplantation and transplant management remain principally dependent on data from retrospective analyses and on the clinical experience of the transplant centers. This consensus document from the European Blood and Marrow Transplantation Inborn Error Working Party and the Paediatric Diseases Working Party aims to report new data and provide consensus-based recommendations on indications for hematopoietic stem cell transplantation and transplant management.
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23
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Mikles B, Bhatia M, Oyeku SO, Jin Z, Green NS. Pediatric hematology providers on referral for transplant evaluation for sickle cell disease: a regional perspective. J Pediatr Hematol Oncol 2014; 36:566-71. [PMID: 24633300 PMCID: PMC4196668 DOI: 10.1097/mph.0000000000000147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hematology referral for evaluation is a key step for hematopoietic stem cell transplantation for sickle cell disease (SCD). Pediatric SCD providers in the US Northeast (New York-Mid-Atlantic and New England regions) were surveyed anonymously for perspectives and practices regarding transplant referral and compared by whether they practiced at SCD transplant centers. Data were analyzed using the Fisher exact test, χ test, and logistic regression. Half of the respondents practiced primarily at transplant sites. Most (79%) were enthusiastic about transplant for SCD and 78% had recently referred ≥1 child for evaluation. Overall, 77% limited referral to certain sickle hemoglobinopathies and 44% preferred referral for β-thalassemia to SCD. Indications selected for referral resembled current transplant criteria, plus family request or poor response to therapy. Referral for children on chronic transfusions predicted enthusiasm and prior referral. Many (66%) referred children with multiple SCD complications, even without matched sibling donors, 37% with sibling donors despite limited disease. Practitioners at transplant centers more commonly accepted event-free survival rates of ≤90% (P=0.002). Northeastern providers expressed varying enthusiasm for referral for evaluation based on eligibility, donor availability, and acceptable risk, with modestly more interest from practitioners at transplant centers. Differing provider perspectives may affect patient referral for transplant consideration.
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Affiliation(s)
- Bethany Mikles
- Department of Pediatric Hematology/Oncology, Naval Medical Center Portsmouth, Portsmouth, VA
| | - Monica Bhatia
- Pediatric Hematology, Oncology and Stem Cell Transplantation
| | - Suzette O. Oyeku
- Department of Pediatrics, Division of General Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center
| | - Nancy S. Green
- Pediatric Hematology, Oncology and Stem Cell Transplantation
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Thompson AL, Bridley A, Twohy E, Dioguardi J, Sande J, Hsu LL, Kamani N, Meier ER. An educational symposium for patients with sickle cell disease and their families: results from surveys of knowledge and factors influencing decisions about hematopoietic stem cell transplant. Pediatr Blood Cancer 2013; 60:1946-51. [PMID: 23900784 DOI: 10.1002/pbc.24704] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/03/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND The only available cure for sickle cell disease (SCD) is hematopoietic stem cell transplant (HSCT). One important barrier to HSCT in SCD is lack of patient and family knowledge. PROCEDURE To improve awareness of HSCT as a curative option for SCD, we hosted half-day educational symposia in 2011 and 2012. Symposia included didactic lectures by HSCT experts, small group sessions, and question and answer sessions with SCD patients and their families who had undergone HSCT. In 2011, we distributed anonymous pre- and post-symposium knowledge tests to determine how much attendees had learned about transplant. In 2012, we asked attendees to rate the importance of various medical and psychosocial factors in the decision to pursue HSCT. RESULTS Results from 2011 showed that knowledge about HSCT increased significantly after the symposium. Concern about the risk of transplant decreased slightly, but not significantly, following the symposium, and the majority of attendees expressed a desire to speak with physicians further about HSCT. In 2012, families reported that risk of death, prevention of SCD complications, and risk of serious complications were the most important considerations for their decisions about HSCT. CONCLUSIONS A half-day symposium for SCD patients and their families can increase knowledge about HSCT. Education about risks and benefits of HSCT is key, as families consider these medical factors to be most important to their decision to pursue transplant. Our symposia can be replicated across the country to increase knowledge about HSCT for SCD and impact the number of patients who pursue HSCT.
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Affiliation(s)
- Amanda L Thompson
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, District of Columbia; Department of Pediatrics, The George Washington University Medical Center, Washington, District of Columbia
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