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Mehta A, Belmatoug N, Bembi B, Deegan P, Elstein D, Göker-Alpan Ö, Lukina E, Mengel E, Nakamura K, Pastores GM, Pérez-López J, Schwartz I, Serratrice C, Szer J, Zimran A, Di Rocco M, Panahloo Z, Kuter DJ, Hughes D. Exploring the patient journey to diagnosis of Gaucher disease from the perspective of 212 patients with Gaucher disease and 16 Gaucher expert physicians. Mol Genet Metab 2017; 122:122-129. [PMID: 28847676 DOI: 10.1016/j.ymgme.2017.08.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 11/17/2022]
Abstract
Gaucher disease (GD) is a rare hereditary disorder caused by a deficiency of the lysosomal enzyme β-glucocerebrosidase. Diagnosis is challenging owing to a wide variability in clinical manifestations and severity of symptoms. Many patients may experience marked delays in obtaining a definitive diagnosis. The two surveys reported herein aimed to explore the patient journey to diagnosis of GD from the perspectives of Gaucher expert physicians and patients. Findings from the surveys revealed that many patients experienced diagnostic delays and misdiagnoses, with nearly 1 in 6 patients stating that they were not diagnosed with GD for 7years or more after first consulting a doctor. Physicians and patients both reported multiple referrals to different specialties before a diagnosis of GD was obtained, with primary care, haematology/haematology-oncology and paediatrics the main specialties to which patients first presented. Splenomegaly, thrombocytopenia, anaemia and bone pain were reported as the most common medical problems at first presentation in both surveys. These findings support a clear need for straightforward and easy-to-follow guidance designed to assist non-specialists to identify earlier patients who are at risk of GD.
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Affiliation(s)
- Atul Mehta
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital, UCL Medical School, London, UK.
| | - Nadia Belmatoug
- Referral Centre for Lysosomal Diseases, University Hospital Paris Nord Val de Seine, Clichy, France.
| | - Bruno Bembi
- Academic Medical Centre Hospital of Udine, Regional Coordinator Centre for Rare Diseases, Udine, Italy.
| | | | | | - Özlem Göker-Alpan
- Lysosomal Disorders Unit and Center for Clinical Trials, O&O Alpan, LLC, Fairfax, VA, USA.
| | - Elena Lukina
- National Research Center for Hematology, Moscow, Russia.
| | - Eugen Mengel
- Villa Metabolica, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
| | | | - Gregory M Pastores
- University College Dublin, and Mater Misericordiae University Hospital, Dublin, Ireland.
| | | | - Ida Schwartz
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Christine Serratrice
- Foundation Hospital Saint Joseph, Marseille, France and Geneva University Hospital, Thonex, Switzerland.
| | - Jeffrey Szer
- Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - Ari Zimran
- Gaucher Clinic, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
| | - Maja Di Rocco
- Unit of Rare Diseases, Department of Pediatrics, Giannina Gaslini Institute, Genoa, Italy.
| | | | - David J Kuter
- Center for Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Derralynn Hughes
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital, UCL Medical School, London, UK.
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Gorovenko NG, Ol’khovich NV, Nedoboy AM, Pichkur NO. Determining the frequency of common mutations in the GBA gene in patients with Gaucher disease in Ukraine. CYTOL GENET+ 2007. [DOI: 10.3103/s009545270704007x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Caubel I, Billette de Villemeur T, Belmatoug N. [Gaucher's disease in children: first clinical signs, natural course and benefits of enzyme replacement therapy]. Arch Pediatr 2003; 10:681-8. [PMID: 12921999 DOI: 10.1016/s0929-693x(03)00286-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Gaucher's disease is a rare genetic disease. Paediatric patients present with highly severe disease and, until now, literature does not provide many descriptions in children only. A specific enzyme replacement therapy has been available for the last decade. Quality of life has been improved by the treatment. POPULATION AND METHODS We studied 17 Gaucher patients (14 type 1 and 3 type 3) diagnosed before the age of 15 and treated afterwards. The first clinical signs and the course of the disease are described before and during treatment. To appreciate the impact of the treatment on quality of life, we established a clinical score with the functional symptoms of the patients. RESULTS The mean age was 6.4 years at diagnosis and 18.3 years at the beginning of the treatment. With specific treatment, all clinical and biological symptoms dramatically improved but some specific organic damages were irreversible. CONCLUSION The comparison of our patients with other reported paediatric cases confirm that Gaucher's disease in children is severe and has to be precociously diagnosed and treated. Clinical scores appeared to be helpful to choose the moment for treating and to follow-up the patients under treatment.
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Affiliation(s)
- I Caubel
- Neuropédiatrie, hôpital d'enfants Armand-Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
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Barbier C, Devisme L, Dobbelaere D, Noizet O, Nelken B, Gottrand F. Neonatal cholestasis and infantile Gaucher disease: a case report. Acta Paediatr 2003; 91:1399-401. [PMID: 12578302 DOI: 10.1111/j.1651-2227.2002.tb02841.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To report on clinical complications of liver disease occurring during Gaucher disease. METHODS A case of Gaucher disease was revealed by neonatal cholestasis and early onset of portal hypertension. RESULTS At 7 d of age, a newborn was admitted for cholestasis associated with hepatosplenomegaly and thrombocytopenia. At that time, bone marrow aspirate and liver biopsy did not reveal any engorged cells. The clinical course was marked by early progressive portal hypertension, and the patient died of uncontrollable upper gastrointestinal bleeding. The histological results of the postmortem showed that Gaucher cells were present in the liver, spleen and bone marrow. The diagnosis was confirmed by enzymatic studies. CONCLUSION Isolated neonatal cholestasis could be the first sign of Gaucher disease. Gaucher disease should always be considered in such circumstances, even if, initially, the bone marrow aspirate and liver biopsy do not reveal any engorged cells.
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Affiliation(s)
- C Barbier
- Unit of Gastroenterology, Jeanne de Flandre Hospital, Lille University Hospital, France
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