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Druye AA, Amoadu M, Boso CM, Nabe B, Kagbo JE, Alhassan A, Odonkor FO, Lanyo GS, Davies AE, Doe PF, Okantey C, Ofori GO, Agyare DF, Abraham SA. Self-management needs, strategies and support for individuals with sickle cell disease in developing countries: a scoping review. BMJ Open 2024; 14:e087723. [PMID: 39260843 PMCID: PMC11409251 DOI: 10.1136/bmjopen-2024-087723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) poses a significant global health burden, particularly affecting individuals in developing countries with constrained healthcare resources. While research on self-management in the context of SCD is emerging, it has predominantly focused on primary studies. The aim of the scoping review was to identify and map self-management needs of individuals living with SCD, the strategies they employed to meet those needs, and the support interventions available to them. METHODS AND ANALYSIS The review was conducted following the Askey and O'Malley's framework to examine the landscape of SCD self-management research. Searches were conducted in PubMed, Scopus, Embase and Dimensions AI, with additional searches in other databases from inception to June 2024 included. Evidence from 14 studies was synthesised to identify self-management needs, strategies and interventions for individuals with SCD. RESULTS The review identified diverse self-management needs among individuals with SCD, including knowledge deficits, emotional challenges, physical limitations and barriers to healthcare access. Various self-management strategies were reported, such as nutritional management, psychological coping techniques and proactive healthcare management. Self-management interventions, predominantly delivered by healthcare professionals, focused on providing education, skills training and support to individuals with SCD. The outcomes of self-management interventions consistently demonstrated significant improvements across various dimensions, including self-efficacy, knowledge enhancement, self-care practices and psychological well-being among individuals with SCD. CONCLUSION This scoping review underscores the importance of addressing the diverse self-management needs of individuals with SCD through tailored interventions and support systems to enhance overall well-being and disease management. Healthcare professionals should prioritise the implementation of multidisciplinary self-management interventions that encompass medical, emotional and social aspects of care to effectively support individuals with SCD in managing their condition. Future research should focus on longitudinal studies to assess the long-term effectiveness of self-management interventions in improving patient outcomes.
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Affiliation(s)
- Andrews Adjei Druye
- Adult Health Department, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Mustapha Amoadu
- Biomedical and Clinical Research Centre, University of Cape Coast, Cape Coast, Ghana
| | - Christian Makafui Boso
- Adult Health Department, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Bernard Nabe
- Adult Health Department, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Justice Enock Kagbo
- Adult Health Department, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Amidu Alhassan
- Adult Health Department, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Frank Offei Odonkor
- Adult Health Department, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Godswill Sedinam Lanyo
- Adult Health Department, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Anita Efua Davies
- Adult Health Department, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Patience Fakornam Doe
- Department of Public Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Christiana Okantey
- Adult Health Department, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Godson Obeng Ofori
- Adult Health Department, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Dorcas Frempomaa Agyare
- Adult Health Department, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Susanna Aba Abraham
- Department of Public Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
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Weckman A, McDonald CR, Naggayi SK, Soranno DE, Conroy AL, Batte A. Sex-disaggregated analysis of acute kidney injury in hospitalized children with sickle cell anemia in Uganda. Am J Physiol Renal Physiol 2024; 327:F304-F313. [PMID: 38932693 DOI: 10.1152/ajprenal.00385.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 06/13/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
A growing body of research is categorizing sex differences in both sickle cell anemia (SCA) and acute kidney injury (AKI); however, most of this work is being conducted in high-resource settings. Here, we evaluated risk factors and clinical parameters associated with AKI and AKI severity, stratified by sex, in a cohort of children hospitalized with SCA and vaso-occlusive pain crisis (VOC). The purpose of this study was to explore sex disparities in a high-risk, vulnerable population. This study was a secondary analysis of data collected from a cohort of Ugandan children between 2 and 18 yr of age prospectively enrolled. A total of 185 children were enrolled in the primary study; 41.6% were female and 58.4% were male, with a median age of 8.9 yr. Incident or worsening AKI (P = 0.026) occurred more frequently in female compared with male children, despite no differences in AKI on admission. Female children also had altered markers of renal function including higher creatinine levels at admission (P = 0.03), higher peak creatinine (P = 0.006), and higher urine neutrophil gelatinase-associated lipocalin (NGAL) at admission (P = 0.003) compared with male children. Female children had elevated total (P = 0.045) and conjugated bilirubin at admission (P = 0.02) compared with male children and higher rates of hematuria at admission (P = 0.004). Here, we report sex differences in AKI in children with SCA and VOC, including increased incidence and worsening of AKI in female pediatric patients, in association with an increase in biological indicators of poor renal function including creatinine, estimated glomerular filtration rate, and NGAL.NEW & NOTEWORTHY In this study, we report an increased risk of developing acute kidney injury (AKI) during hospitalization, worsening AKI, and death among females with sickle cell anemia (SCA) hospitalized with an acute pain crisis compared with males. The sex differences in AKI were not explained by socioeconomic differences, severity of pain, or disease severity among females compared with males. Together, these data suggest that female children with SCA may be at increased risk of AKI.
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Affiliation(s)
- Andrea Weckman
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Chloe R McDonald
- Sandra A. Rotman Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Danielle E Soranno
- Department of Pediatric Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Department of Bioengineering, Purdue University, West Lafayette, Indiana, United States
| | - Andrea L Conroy
- Global Health Uganda Research Collaboration, Kampala, Uganda
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Anthony Batte
- Global Health Uganda Research Collaboration, Kampala, Uganda
- Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
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Bhattacharjee S, Ghosh S, Shaw J, Bhattacharjee S, Bhattacharyya M. Thalidomide and Hydroxyurea in Transfusion-Dependent Thalassemia: Efficacy, Safety Profile and Impact on Quality of Life. Hemoglobin 2024; 48:161-168. [PMID: 39092801 DOI: 10.1080/03630269.2024.2386076] [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: 04/22/2024] [Revised: 06/28/2024] [Accepted: 07/12/2024] [Indexed: 08/04/2024]
Abstract
Transfusion-dependent thalassemia (TDT) is a major public health concern in India, requiring regular transfusions for survival. There is also significant morbidity caused by iron overload and transfusion related infections. Novel therapies targeting fetal hemoglobin induction are the need of the hour in resource-poor institutions for patients where transplant is not feasible for various reasons. This single arm, non-randomised prospective trial evaluated the efficacy and safety of a combination of low dose thalidomide and hydroxyurea in TDT along with the impact on quality of life (QoL). It included 41 TDT patients, who failed a reasonable trial of hydroxyurea. Complete response (CR) was defined as transfusion independence and partial response (PR) denoted at least a 50% reduction in transfusion requirement. The rest were defined as non-responders (NR). The mean age of the cohort was 20.78 years (range 12-45 years). There were 13 males and 28 females. Nineteen (46.3%), 7 (17.1%), and 15 (36.6%) patients achieved CR, PR, and no response respectively. The overall response rate (CR + PR) was 63.4%. There was a significant increase in hemoglobin levels with decrement in transfusion burden and ferritin levels. There were no significant adverse reactions. No significant predictors of response were found including amongst genetic modifiers. It improved the health related QoL amongst responders. The combination of thalidomide and hydroxyurea appear safe and effective in the reduction in transfusion requirement of TDT patients. The judicious use of these drugs can improve the quality of life and pave the way for patients not eligible for a stem cell transplant.
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Affiliation(s)
- Sukrita Bhattacharjee
- Institute of Haematology and Transfusion Medicine, Medical College and Hospital, Kolkata, India
| | - Shouriyo Ghosh
- Tata Medical Center, Clinical Haematology and Cellular Therapies, Kolkata, India
| | - Jyoti Shaw
- Institute of Haematology and Transfusion Medicine, Medical College and Hospital, Kolkata, India
| | - Sunistha Bhattacharjee
- Institute of Haematology and Transfusion Medicine, Medical College and Hospital, Kolkata, India
| | - Maitreyee Bhattacharyya
- Institute of Haematology and Transfusion Medicine, Medical College and Hospital, Kolkata, India
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Soubrier C, Jean E, De Sainte Marie B, Agouti I, Seguier J, Lavoipierre V, Clapasson C, Iline N, Gonin J, Giorgi R, Schleinitz N, Thuret I, Badens C, Bernit E. [Health status and quality of life in β-thalassemia adults in Marseille, France]. Rev Med Interne 2024; 45:187-193. [PMID: 38519305 DOI: 10.1016/j.revmed.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/17/2023] [Accepted: 01/01/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION The life expectancy of β-thalassemia patients has increased over the last 20 years. In this study, we evaluated the current health status and quality of life of these patients managed in a reference center in Marseille. METHODS This is a single-center, descriptive study conducted between June and August 2019 in patients over 18 years of age with β-thalassemia major or intermedia. Clinical and paraclinical data were collected retrospectively and the SF-36 health survey questionnaire was proposed to each patient. RESULTS 43 of 64 selected patients were included and divided into 2 groups: 35 patients with transfusion-dependent β-thalassemia and 8 patients with non-transfusion-dependent β-thalassemia. Liver iron overload is the most frequent complication, present in 80% of transfusion-dependent and 62.5% of non-transfusion-dependent patients. Cardiac iron overload is present only in the transfusion dependent β-thalassemia group (20%). Hypogonadotropic hypogonadism remains the most common endocrine disorder (41.9%) followed by osteoporosis (37.2%). Among the 31 patients who completed the SF-36 questionnaire, physical and mental quality of life scores were lowered in transfusion dependent (respectively 42.7 and 46.8) as in non-transfusion-dependent patients (respectively 43.8 and 28.9). CONCLUSION Despite an improvement in medical care, our patients with β-thalassemia show an alteration in their quality of life that will need to be characterized in the entire French cohort.
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Affiliation(s)
- C Soubrier
- Service de médecine interne et médecine polyvalente, centre hospitalier d'Ajaccio Notre-Dame de la Miséricorde, site du Stilettu, 1180, route A.-Madunuccia, 20090 Ajaccio, France.
| | - E Jean
- Département de médecine interne, AP-HM, hôpital Timone, 264, rue Saint-Pierre, 13385 Marseille cedex, France
| | - B De Sainte Marie
- Département de médecine interne, AP-HM, hôpital Timone, 264, rue Saint-Pierre, 13385 Marseille cedex, France
| | - I Agouti
- Centre de référence des syndromes drépanocytaires majeurs, thalassémies et autres pathologies rares du globule rouge et de l'érythropoïèse, hôpital de la Timone, AP-PH, 264, rue Saint-Pierre, 13385 Marseille cedex, France
| | - J Seguier
- Département de médecine interne, AP-HM, hôpital Timone, 264, rue Saint-Pierre, 13385 Marseille cedex, France
| | - V Lavoipierre
- Service de médecine interne, centre hospitalier de Martigues, 3, boulevard des Rayettes, BP 50248, 13698 Martigues cedex, France
| | - C Clapasson
- Établissement français du sang, région PACA, 149, boulevard Baille, 13005 Marseille, France
| | - N Iline
- AP-HM, Hop Timone, BioSTIC, biostatistiques et technologies de l'information et de la communication, Marseille, France
| | - J Gonin
- AP-HM, Hop Timone, BioSTIC, biostatistiques et technologies de l'information et de la communication, Marseille, France
| | - R Giorgi
- AP-HM, Hop Timone, BioSTIC, biostatistiques et technologies de l'information et de la communication, Marseille, France; Aix Marseille université, AP-HM, Inserm, IRD, SESSTIM, sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
| | - N Schleinitz
- Département de médecine interne, AP-HM, hôpital Timone, 264, rue Saint-Pierre, 13385 Marseille cedex, France; Aix-Marseille université, Marseille, France
| | - I Thuret
- Centre de référence des syndromes drépanocytaires majeurs, thalassémies et autres pathologies rares du globule rouge et de l'érythropoïèse, hôpital de la Timone, AP-PH, 264, rue Saint-Pierre, 13385 Marseille cedex, France
| | - C Badens
- Laboratoire de biochimie, AP-HM, hôpital Timone, 264, rue Saint-Pierre, 13385 Marseille cedex, France
| | - E Bernit
- Unité transversale de la drépanocytose, centre de référence Antilles-Guyane pour la drépanocytose, les thalassémies et les maladies constitutives du globule rouge et de l'érythropoïèse, CHU Guadeloupe, pôle parents-enfants, hôpital Ricou, BP465, 97159 Pointe-à-Pitre cedex, France
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Klonizakis P, Roy N, Papatsouma I, Mainou M, Christodoulou I, Pantelidou D, Kokkota S, Diamantidis M, Kourakli A, Lazaris V, Andriopoulos D, Tsapas A, Klaassen RJ, Vlachaki E. A Cross-Sectional, Multicentric, Disease-Specific, Health-Related Quality of Life Study in Greek Transfusion Dependent Thalassemia Patients. Healthcare (Basel) 2024; 12:524. [PMID: 38470634 PMCID: PMC10931193 DOI: 10.3390/healthcare12050524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
The assessment of health-related quality of life (HRQoL) in thalassemia offers a holistic approach to the disease and facilitates better communication between physicians and patients. This study aimed to evaluate the HRQoL of transfusion-dependent thalassemia (TDT) patients in Greece. This was a multicentric, cross-sectional study conducted in 2017 involving 283 adult TDT patients. All participants completed a set of two QoL questionnaires, the generic SF-36v2 and the disease-specific TranQol. Demographic and clinical characteristics were used to predefine patient subgroups. Significant factors identified in the univariate analysis were entered into a multivariate analysis to assess their effect on HRQoL. The SF-36 scores of TDT patients were consistently lower compared to the general population in Greece. The mean summary score of TranQol was relatively high (71 ± 14%), exceeding levels observed in national surveys in other countries. Employment emerged as the most significant independent factor associated with better HRQoL, whereas age had the most significant negative effect. This study represents the first comprehensive QoL assessment of a representative sample of the TDT population in Greece. The implementation of TranQol allowed for the quantification of HRQoL in Greece, establishing a baseline for future follow-up, and identifying more vulnerable patient subgroups.
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Affiliation(s)
- Philippos Klonizakis
- Adults Thalassemia Unit-2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (M.M.); (I.C.); (E.V.)
| | - Noémi Roy
- Department of Haematology, Oxford University Hospitals, NHS Foundation Trust, Oxford OX3 0AG, UK;
| | - Ioanna Papatsouma
- Department of Mathematics, Imperial College London, London SW7 2BP, UK;
| | - Maria Mainou
- Adults Thalassemia Unit-2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (M.M.); (I.C.); (E.V.)
| | - Ioanna Christodoulou
- Adults Thalassemia Unit-2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (M.M.); (I.C.); (E.V.)
| | - Despina Pantelidou
- Thalassemia Unit, AHEPA General Hospital of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.K.)
| | - Smaro Kokkota
- Thalassemia Unit, AHEPA General Hospital of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.K.)
| | - Michael Diamantidis
- Thalassemia and Sickle Cell Disease Unit, General Hospital of Larissa, 41110 Larissa, Greece;
| | - Alexandra Kourakli
- Thalassemia and Hemoglobinopathies Center, University Hospital of Patras, 26504 Patras, Greece; (A.K.); (V.L.)
| | - Vasileios Lazaris
- Thalassemia and Hemoglobinopathies Center, University Hospital of Patras, 26504 Patras, Greece; (A.K.); (V.L.)
| | - Dimitrios Andriopoulos
- Haemato-Oncology Department, Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK;
| | - Apostolos Tsapas
- 2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
| | - Robert J. Klaassen
- Department of Pediatrics, Division of Hematology/Oncology, University of Ottawa, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada;
| | - Efthymia Vlachaki
- Adults Thalassemia Unit-2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (M.M.); (I.C.); (E.V.)
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Sisler I, McClish DK, Villella A, Valrie C, Smith WR. Impact of community health workers on quality of life in adolescents and young adults with sickle cell disease: The SHIP-HU study. Br J Haematol 2024; 204:649-657. [PMID: 37779237 DOI: 10.1111/bjh.19113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023]
Abstract
Health-related quality of life (HRQoL) is an important outcome for patients with sickle cell disease (SCD). It is often poor compared with other chronic medical conditions or measured as a multidomain disease-specific construct. We previously reported outcomes in the Start Healing in Patients with Hydroxyurea (SHIP-HU) randomized controlled trial in adolescents and adults with SCD at six clinical sites. Besides the primary outcomes, we also measured HRQoL as a secondary outcome. Patients in the intervention arm were each assigned community health workers (CHWs) who provided case management services. CHW services were independent of medical management, and medical managers were blinded to the study arm. Patients in the control arm received only standard of care. We hypothesized that having a CHW would improve HRQoL in patients enrolled in SHIP-HU. We did not find significant differences between domains of HRQoL in the two study arms. Possible explanations include selection bias of enrolled versus unenrolled patients, selection bias of sites, medical providers and medical management, enforced blinding, and a lack of cooperation between medical managers and CHWs. The importance of CHWs and HRQoL is nonetheless recognized based on the literature. Future interventions on HRQoL in SCD should consider alternative study designs and multimodal interventions.
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Affiliation(s)
- India Sisler
- Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, Virigina, USA
| | - Donna K McClish
- Health Care System, Virginia Commonwealth University Health System, Richmond, Virigina, USA
| | - Anthony Villella
- Department of Hematology and Oncology, Nationwide Children's Hospital Hematology Oncology & Blood and Marrow Transplant, Columbus, Ohio, USA
| | - Cecelia Valrie
- Department of Psychology, Virginia Commonwealth University, Richmond, Virigina, USA
| | - Wally R Smith
- Health Care System, Virginia Commonwealth University Health System, Richmond, Virigina, USA
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Wangi K, Birriel B, Smith C. Psychosocial burden in transfusion dependent beta-thalassemia patients and its impact on the quality of life and the problem of dignity. J Taibah Univ Med Sci 2023; 18:1217-1219. [PMID: 37250810 PMCID: PMC10209453 DOI: 10.1016/j.jtumed.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Beta-thalassemia major is a genetic blood disorder that impacts hemoglobin production with several symptoms that decrease quality of life in patients. Blood transfusions may help them to regulate their hemoglobin needs, though this is a lifelong intervention. Struggling with dependent blood transfusion status impacts patients greatly including their bio, psycho, social, and spiritual health, potentially raising a bioethical issue related to human dignity.
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Affiliation(s)
- Karolus Wangi
- Ross & Carol Nese College of Nursing, Pennsylvania State University, 307 Nursing Science Building, University Park, PA, USA
| | - Barbara Birriel
- Nursing and Bioethics, Ross & Carol Nese College of Nursing, Pennsylvania State University, Hershey, PA, USA
| | - Colin Smith
- Department of Philosophy, College of Liberal Arts, Pennsylvania State University, 234 Sparks Building, University Park, PA, USA
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Mulas O, Efficace F, Orofino MG, Piroddi A, Piras E, Vacca A, Barella S, Costa A, Giesinger JM, La Nasa G, Caocci G. Health-Related Quality-of-Life Profile of Pediatric Patients with β Thalassemia after Hematopoietic Stem Cell Transplantation. J Clin Med 2023; 12:6047. [PMID: 37762987 PMCID: PMC10532003 DOI: 10.3390/jcm12186047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Matched hematopoietic stem cell transplantation (HSCT) is a feasible and curative treatment in pediatric patients with beta thalassemia major (β-TM). However, little data are available regarding patients and their parents' health-related quality of life (HRQoL) after the procedure. As such, we investigated the HRQoL of pediatric patients with β-TM after HSCT compared to that of patients treated with blood transfusions and iron chelation. The health-related quality of life of 43 β-TM pediatric patients and 43 parents were evaluated using the Pediatric Quality of Life Inventory (PedsQL). A total of 25 patients underwent HSCT: 15 from a sibling and 10 from an HLA-matched donor. The median follow-up time from HSCT was 5 years (range 1-13 years). The mean ages at the survey were 10.1 years (range 5-15) and 9.6 years (range 5-15) for transfused and transplanted patients, respectively. A significant reduction in HRQoL was reported in the group of transfused patients compared with that of patients transplanted in the following PedsQL domains: children's and parents' physical functions, Δ = -15.4, p = 0.009 and Δ = -11.3, p = 0.002, respectively; children's and parents' emotional functioning, Δ = -15.2, p = 0.026 and Δ = -15.2, p = 0.045, respectively; child's and parents' school functioning, Δ = -25, p = 0.005 and Δ = -22.5, p = 0.011, respectively; total child and parents scores, Δ = -14.5, p = 0.004 and Δ = -13.2, p = 0.005, respectively. The results of a multivariable analysis showed that the HSCT procedure was significantly associated with a higher total child PedsQL score (adjusted mean difference = 15.3, p = 0.001) and a higher total parent PedsQL score (adjusted mean difference = 14.1, p = 0.006). We found no significant difference in the HRQoL measured after sibling or unrelated human leukocyte antigen (HLA)-matched HSCT. Finally, a significant positive correlation across all the PedsQL domains was found between the scores reported by the children and those reported by their parents. In conclusion, our study shows that HSCT in pediatric patients with β-TM is associated with a good overall HRQoL profile. This information further supports physicians when counseling patients and their parents before the HSCT procedure.
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Affiliation(s)
- Olga Mulas
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center, 00161 Rome, Italy;
| | - Maria Grazia Orofino
- Bone Marrow Transplant Center, Pediatric Hospital “Microcitemico A. Cao”, 09121 Cagliari, Italy; (M.G.O.); (A.P.)
| | - Antonio Piroddi
- Bone Marrow Transplant Center, Pediatric Hospital “Microcitemico A. Cao”, 09121 Cagliari, Italy; (M.G.O.); (A.P.)
| | - Eugenia Piras
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
| | - Adriana Vacca
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
| | - Susanna Barella
- Pediatric Clinic, Thalassemia and Rare Diseases, Pediatric Hospital “Microcitemico A. Cao”, 09121 Cagliari, Italy;
| | - Alessandro Costa
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
| | - Johannes M. Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Giorgio La Nasa
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
| | - Giovanni Caocci
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
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