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Ettingshausen CE, Hermans C, Holme PA, Cid AR, Khair K, Oldenburg J, Négrier C, Botha J, Lelli A, Windyga J. Real-world data in patients with congenital hemophilia and inhibitors: final data from the FEIBA Global Outcome (FEIBA GO) study. Ther Adv Hematol 2023; 14:20406207231184323. [PMID: 37529276 PMCID: PMC10387704 DOI: 10.1177/20406207231184323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/08/2023] [Indexed: 08/03/2023] Open
Abstract
Background The bypassing agent, activated prothrombin complex concentrate [aPCC, FEIBA (factor VIII inhibitor bypass activity); Baxalta US Inc, a Takeda company, Lexington, MA, USA], is indicated for the treatment of bleeding episodes, perioperative management, and routine prophylaxis in patients with hemophilia A or B with inhibitors. In certain countries, aPCC is also indicated for the treatment of bleeding episodes and perioperative management in patients with acquired hemophilia A. Objectives To describe long-term, real-world effectiveness, safety, and quality-of-life outcomes for patients with congenital hemophilia A or B and high-responding inhibitors receiving aPCC treatment in routine clinical practice. Design FEIBA Global Outcome (FEIBA GO; EUPAS6691) was a prospective, observational study. Methods Investigators determined the treatment regimen and clinical monitoring frequency. The planned patient observation period was 4 years. Data are from the safety analysis set (patients who received ⩾1 aPCC infusion). Results Overall, 50 patients received either aPCC prophylaxis (n = 37) or on-demand therapy (n = 13) at screening [hemophilia A, n = 49; hemophilia B, n = 1; median (range) age, 16.5 [2-71] years). Mean ± standard deviation overall annualized bleeding rate and annualized joint bleeding rate for patients receiving prophylaxis were 6.82 ± 11.52 and 3.77 ± 5.71, respectively, and for patients receiving on-demand therapy were 10.94 ± 11.27 and 6.94 ± 7.39, respectively. Overall, 177 and 31 adverse events (AEs) were reported in 28 of 40 and 10 of 13 patients receiving prophylaxis or on-demand therapy, respectively. Two serious AEs were considered possibly related to aPCC: acute myocardial infarction due to coronary artery embolism in one patient receiving prophylaxis. No thrombotic microangiopathy was reported. No AEs resulted in death. Conclusion This study demonstrated the long-term, real-world effectiveness and consistent safety profile of aPCC as on-demand therapy and prophylactic treatment in patients with hemophilia and high-responding inhibitors. Trial registry FEIBA Global Outcome Study; EUPAS6691 https://www.encepp.eu/encepp/viewResource.htm?id=32774.
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Affiliation(s)
| | - Cedric Hermans
- Hemostasis and Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Pål A. Holme
- Department of Haematology, Oslo University Hospital and Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ana R. Cid
- Unidad de Hemostasia y Trombosis, Hospital Universitario y Politécnico La Fe, València, Spain
| | - Kate Khair
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children, London, UK
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, Bonn University Clinic, Bonn, Germany
| | | | - Jaco Botha
- Takeda Pharmaceuticals International AG, Zürich, Switzerland
| | | | - Jerzy Windyga
- Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
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2
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Martos L, Fernández-Pardo Á, López-Fernández MF, Ibáñez F, Herrero S, Tàssies D, González-Porras JR, Solmoirago MJ, Costa MJ, Reverter JC, Marco P, Roldán V, Lecumberri R, Velasco F, Oto J, Iruin G, Alonso MN, Vayá A, Bonanad S, Ferrando F, Martí E, Cid AR, Plana E, Oña F, Cuesta I, González-López TJ, España F, Medina P, Navarro S. Identification of 58 Mutations (26 Novel) in 94 of 109 Symptomatic Spanish Probands with Protein C Deficiency. Thromb Haemost 2019; 119:1409-1418. [PMID: 31254973 DOI: 10.1055/s-0039-1692440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Presently, no data on the molecular basis of hereditary protein C (PC) deficiency in Spain is available. We analyzed the PC gene (PROC) in 109 patients with symptomatic PC deficiency and in 342 relatives by sequencing the 9 PROC exons and their flanking intron regions. In 93 probands, we found 58 different mutations (26 novel). Thirty-seven consisted of a nucleotide change, mainly missense mutations, 1 was a 6-nucleotide insertion causing the duplication of 2 amino acids, and 4 were deletions of 1, 3, 4, and 16 nucleotides. Nine mutations caused type II deficiencies, with the presence of normal antigen levels but reduced anticoagulant activity. Using a PC level of 70% as lowest normal limit, we found no mutations in 16 probands and 25 relatives with PC levels ≤ 70%. On the contrary, 4 probands and 12 relatives with PC levels > 70% carried the mutation identified in the proband. The spectrum of recurrent mutations in Spain is different from that found in the Netherlands, where the most frequent mutations were p.Gln174* and p.Arg272Cys, and is more similar to that found in France, where the most frequent were p.Arg220Gln and p.Pro210Leu. In our study, p.Val339Met (9 families), p.Tyr166Cys (7), p.Arg220Gln (6), and p.Glu58Lys (5) were the most prevalent. This study confirms the considerable heterogeneity of the genetic abnormality in PC deficiencies, and allowed genetic counseling to those individuals whose PC levels were close to the lower limit of the normal reference range.
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Affiliation(s)
- Laura Martos
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Álvaro Fernández-Pardo
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Sonia Herrero
- Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | | | - María J Solmoirago
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María J Costa
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Pascual Marco
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Vanessa Roldán
- Hospital General Universitario Morales Meseguer, Murcia, Spain
| | | | - Francisco Velasco
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Julia Oto
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gemma Iruin
- Hospital de Cruces, Baracaldo, Bilbao, Spain
| | | | - Amparo Vayá
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Santiago Bonanad
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Unidad de Trombosis y Hemostasia, Servicio de Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Fernando Ferrando
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Unidad de Trombosis y Hemostasia, Servicio de Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Ana R Cid
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Unidad de Trombosis y Hemostasia, Servicio de Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Emma Plana
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Francisca Oña
- Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | - Tomás J González-López
- Hospital Universitario de Burgos y Departamento de Ciencias de la Salud, Universidad de Burgos, Burgos, Spain
| | - Francisco España
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pilar Medina
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Silvia Navarro
- Grupo de Investigación en Hemostasia, Trombosis, Arteriosclerosis y Biología Vascular, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
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3
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Cid AR, Montesinos P, Sánchez‐Guiu I, Haya S, Lorenzo JI, Sanz J, Moscardo F, Puig N, Planelles D, Bonanad S, Sanz GF, Vicente V, González‐Manchón C, Lozano ML, Rivera J, Sanz MA. Allogeneic hematopoietic cell transplantation in an adult patient with Glanzmann thrombasthenia. Clin Case Rep 2017; 5:1887-1890. [PMID: 29152293 PMCID: PMC5676254 DOI: 10.1002/ccr3.1206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 07/27/2017] [Accepted: 08/19/2017] [Indexed: 11/17/2022] Open
Abstract
Glanzmann thrombasthenia is a rare bleeding disorder that can present life‐threatening bleeding. Our patients develop antiplatelet antibodies that become refractory to any pharmacological treatment. Allogeneic hematopoietic stem‐cell transplantation is the only currently curative procedure, but has major risks mainly in adult; indeed, our patient died.
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Affiliation(s)
- Ana R. Cid
- Unidad de Hemostasia y TrombosisServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
| | - Pau Montesinos
- Unidad de Trasplante de Células HematopoyéticasServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
| | - Isabel Sánchez‐Guiu
- Servicio de Hematología y Oncología MédicaHospital Universitario Morales MeseguerCentro Regional de HemodonaciónUniversidad de Murcia, IMIB‐Arrixaca, CIBERERMurciaSpain
| | - Saturnino Haya
- Unidad de Hemostasia y TrombosisServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
| | - Jose I. Lorenzo
- Unidad de Trasplante de Células HematopoyéticasServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
| | - Jaime Sanz
- Unidad de Trasplante de Células HematopoyéticasServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
| | - Federico Moscardo
- Unidad de Trasplante de Células HematopoyéticasServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
| | - Nieves Puig
- Centro de Transfusión de la Comunidad ValencianaValenciaSpain
| | | | - Santiago Bonanad
- Unidad de Hemostasia y TrombosisServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
| | - Guillermo F. Sanz
- Unidad de Trasplante de Células HematopoyéticasServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
| | - Vicente Vicente
- Servicio de Hematología y Oncología MédicaHospital Universitario Morales MeseguerCentro Regional de HemodonaciónUniversidad de Murcia, IMIB‐Arrixaca, CIBERERMurciaSpain
| | - Consuelo González‐Manchón
- Departament Cellular and Molecular MedicineCentro de Investigaciones Biológicas (C.S.I.C.)MadridSpain
| | - María L. Lozano
- Servicio de Hematología y Oncología MédicaHospital Universitario Morales MeseguerCentro Regional de HemodonaciónUniversidad de Murcia, IMIB‐Arrixaca, CIBERERMurciaSpain
| | - José Rivera
- Servicio de Hematología y Oncología MédicaHospital Universitario Morales MeseguerCentro Regional de HemodonaciónUniversidad de Murcia, IMIB‐Arrixaca, CIBERERMurciaSpain
| | - Miguel A. Sanz
- Unidad de Hemostasia y TrombosisServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
- Unidad de Trasplante de Células HematopoyéticasServicio de HematologíaHospital Universitario y Politécnico La FeValenciaSpain
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4
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Civaschi E, Klersy C, Melazzini F, Pujol-Moix N, Santoro C, Cattaneo M, Lavenu-Bombled C, Bury L, Minuz P, Nurden P, Cid AR, Cuker A, Latger-Cannard V, Favier R, Nichele I, Noris P. Analysis of 65 pregnancies in 34 women with five different forms of inherited platelet function disorders. Br J Haematol 2015; 170:559-63. [PMID: 25899604 DOI: 10.1111/bjh.13458] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/15/2015] [Indexed: 12/01/2022]
Abstract
This study evaluated 65 pregnancies in 34 women with five different inherited platelet function disorders. Gestation was similar to that of the general population. Severe bleeds requiring blood transfusions were observed in 50% of deliveries in Glanzmann thrombasthenia (GT), but not in the patients with delta storage pool disease, Hermansky-Pudlak syndrome, P2Y12 defect or defect of thromboxane A2 receptor. Of note, severe haemorrhage also occurred in women with GT who had received prophylactic platelet transfusions, suggesting that better preventive treatments are required. Diagnosis and degree of spontaneous bleeding tendency before pregnancy were reliable parameters to predict the delivery-related bleeding risk.
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Affiliation(s)
- Elisa Civaschi
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Catherine Klersy
- Service of Biometry & Statistics, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Federica Melazzini
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Nuria Pujol-Moix
- Universitat Autònoma de Barcelona & Institut de Recerca Biomèdica Sant Pau, Barcelona, Spain
| | - Cristina Santoro
- Ematologia, Policlinico Umberto 1, Università Sapienza, Rome, Italy
| | - Marco Cattaneo
- Dipartimento di Scienze della Salute, Medicina III, Ospedale San Paolo, Università degli Studi di Milano, Milano, Italy
| | - Cécile Lavenu-Bombled
- AP-HP, Hôpital Bicêtre, Hématologie Biologique/Centre de Référence Pathologies Plaquettaires, Le Kremlin Bicêtre, France
| | - Loredana Bury
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Pietro Minuz
- Department of Medicine, University of Verona, Verona, Italy
| | - Paquita Nurden
- Plateforme Technologique et d'Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France
| | - Ana R Cid
- Unidad de Hemostasia y Trombosis, La Fe University Hospital, Valencia, Spain
| | - Adam Cuker
- Department of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Véronique Latger-Cannard
- Centre de Compétence Nord-Est des Pathologies Plaquettaires from the Frame of the Reference French Centre and Service d'Hématologie Biologique, Centre Hospitalo-Universitaire, Nancy, France
| | - Remi Favier
- Haematological Laboratory, AP-HP, Armand Trousseau Children Hospital, French Reference Centre for Inherited Platelet Disorders, Paris, France.,Inserm U1170, Villejuif, France
| | - Ilaria Nichele
- Department of Cell Therapy and Haematology, San Bortolo Hospital, Vicenza, Italy
| | - Patrizia Noris
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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5
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Nijdam A, Altisent C, Carcao MD, Cid AR, Claeyssens-Donadel S, Kurnik K, Ljung R, Nolan B, Petrini P, Platokouki H, Rafowicz A, Thomas AE, Fischer K. Bleeding before prophylaxis in severe hemophilia: paradigm shift over two decades. Haematologica 2014; 100:e84-6. [PMID: 25527565 DOI: 10.3324/haematol.2014.115709] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Annelies Nijdam
- Van Creveldkliniek, Center for Benign Hematology, Thrombosis and Hemostasis, University Medical Center Utrecht, Netherlands
| | | | - Manuel D Carcao
- Division of Haematology/Oncology, Department of Paediatrics and Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ana R Cid
- Unidad de Hemostasia y Trombosis, Hospital Universitario la Fe, Valencia, Spain
| | | | - Karin Kurnik
- Dr. von Haunersches Children's Hospital, University of Munich, Germany
| | - Rolf Ljung
- Lund University, Department of Clinical Sciences Lund -Paediatrics and Malmö Haemostasis & Thrombosis Centre, Skåne University Hospital, Malmö, Sweden
| | - Beatrice Nolan
- Department of Haematology Oncology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Pia Petrini
- Paediatric Department of Coagulation Disorders, Karolinska University Hospital, Stockholm, Sweden
| | - Helen Platokouki
- St. Sophia Children's Hospital, Haemophilia-Haemostasis Unit, Athens, Greece
| | - Anne Rafowicz
- Centre Régional de Traitement de l'Hémophilie et Autres Maladies Hémorragiques, Centre Hospitalier Universitaire de Bicêtre, Paris, France
| | - Angela E Thomas
- Department of Haematology, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Kathelijn Fischer
- Van Creveldkliniek, Center for Benign Hematology, Thrombosis and Hemostasis, University Medical Center Utrecht, Netherlands Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
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6
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Cabrera N, Moret A, Caunedo P, Cid AR, Vila V, España F, Aznar JA. Comparison of a new chemiluminescent immunoassay for von Willebrand factor activity with the ristocetin cofactor-induced platelet agglutination method. Haemophilia 2013; 19:920-5. [PMID: 23730809 DOI: 10.1111/hae.12203] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2013] [Indexed: 11/28/2022]
Abstract
Measuring von Willebrand factor (VWF) activity is essential for the diagnosis of von Willebrand disease (VWD). The VWF activity is usually assessed based on measurement of the ristocetin cofactor (VWF:RCo). However, that test is technically challenging and has high intra- and inter-assay variabilities. A new automated chemiluminescent immunoassay VWF activity has recently become commercially available (HemosIL AcuStar von Willebrand Factor Ristocetin Cofactor Activity). The main objective of this study was to evaluate this new method and to compare it with the VWF:RCo assay as the reference method. We studied 91 samples, 18 healthy volunteers samples and 73 samples from patients (VWF:RCo level <50 IU dL(-1) ): 29 type 1 VWD, 13 type 2A, 5 type 2B, 5 type 2M, 3 type 2N, 5 type 3, 4 type 3 under treatment, 5 type 3 carriers and 4 samples with other pathologies. The HemosIL AcuStar VWF:RCo assay was 96% sensitive and 100% specific for detecting VWF abnormalities. The good analytical performance, and the sensitivity and specificity of HemosIL AcuStar VWF:RCo to detect VWF deficiency renders it a suitable method for VWD screening.
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Affiliation(s)
- N Cabrera
- Unidad de Hemostasia y Trombosis, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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7
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Gouw SC, van der Bom JG, Ljung R, Escuriola C, Cid AR, Claeyssens-Donadel S, van Geet C, Kenet G, Mäkipernaa A, Molinari AC, Muntean W, Kobelt R, Rivard G, Santagostino E, Thomas A, van den Berg HM. Factor VIII products and inhibitor development in severe hemophilia A. N Engl J Med 2013; 368:231-9. [PMID: 23323899 DOI: 10.1056/nejmoa1208024] [Citation(s) in RCA: 316] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND For previously untreated children with severe hemophilia A, it is unclear whether the type of factor VIII product administered and switching among products are associated with the development of clinically relevant inhibitory antibodies (inhibitor development). METHODS We evaluated 574 consecutive patients with severe hemophilia A (factor VIII activity, <0.01 IU per milliliter) who were born between 2000 and 2010 and collected data on all clotting-factor administration for up to 75 exposure days. The primary outcome was inhibitor development, which was defined as at least two positive inhibitor tests with decreased in vivo recovery of factor VIII levels. RESULTS Inhibitory antibodies developed in 177 of the 574 children (cumulative incidence, 32.4%); 116 patients had a high-titer inhibitory antibody, defined as a peak titer of at least 5 Bethesda units per milliliter (cumulative incidence, 22.4%). Plasma-derived products conferred a risk of inhibitor development that was similar to the risk with recombinant products (adjusted hazard ratio as compared with recombinant products, 0.96; 95% confidence interval [CI], 0.62 to 1.49). As compared with third-generation full-length recombinant products (derived from the full-length complementary DNA sequence of human factor VIII), second-generation full-length products were associated with an increased risk of inhibitor development (adjusted hazard ratio, 1.60; 95% CI, 1.08 to 2.37). The content of von Willebrand factor in the products and switching among products were not associated with the risk of inhibitor development. CONCLUSIONS Recombinant and plasma-derived factor VIII products conferred similar risks of inhibitor development, and the content of von Willebrand factor in the products and switching among products were not associated with the risk of inhibitor development. Second-generation full-length recombinant products were associated with an increased risk, as compared with third-generation products. (Funded by Bayer Healthcare and Baxter BioScience.).
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Affiliation(s)
- Samantha C Gouw
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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8
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Casaña P, Mayo S, Monfort S, Orellana C, Haya S, Cid AR, Roselló M, Oltra S, Martínez F. Large deletion in the Factor VIII gene (F8) involving segmental duplications in int22h shows no haematological phenotype in female carriers, but may be embryonic lethal in males. Br J Haematol 2012; 158:138-40. [DOI: 10.1111/j.1365-2141.2012.09092.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Pilar Casaña
- Unitat de Hemostàsia Trombosi; Hospital Universitari La Fe; Av. Campanar, 21; 46009; Valencia; Spain
| | - Sonia Mayo
- Unitat de Genètica i Diagnòstic Prenatal; Hospital Universitari La Fe; Av. Campanar, 21; 46009; Valencia; Spain
| | - Sandra Monfort
- Unitat de Genètica i Diagnòstic Prenatal; Hospital Universitari La Fe; Av. Campanar, 21; 46009; Valencia; Spain
| | - Carmen Orellana
- Unitat de Genètica i Diagnòstic Prenatal; Hospital Universitari La Fe; Av. Campanar, 21; 46009; Valencia; Spain
| | - Saturnino Haya
- Unitat de Hemostàsia Trombosi; Hospital Universitari La Fe; Av. Campanar, 21; 46009; Valencia; Spain
| | - Ana R. Cid
- Unitat de Hemostàsia Trombosi; Hospital Universitari La Fe; Av. Campanar, 21; 46009; Valencia; Spain
| | - Monica Roselló
- Unitat de Genètica i Diagnòstic Prenatal; Hospital Universitari La Fe; Av. Campanar, 21; 46009; Valencia; Spain
| | - Silvestre Oltra
- Unitat de Genètica i Diagnòstic Prenatal; Hospital Universitari La Fe; Av. Campanar, 21; 46009; Valencia; Spain
| | - Francisco Martínez
- Unitat de Genètica i Diagnòstic Prenatal; Hospital Universitari La Fe; Av. Campanar, 21; 46009; Valencia; Spain
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9
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10
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Casaña P, Haya S, Cid AR, Oltra S, Martínez F, Cabrera N, Aznar JA. Identification of deletion carriers in hemophilia B: quantitative real-time polymerase chain reaction or multiple ligation probe amplification. Transl Res 2009; 153:114-7. [PMID: 19218093 DOI: 10.1016/j.trsl.2008.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 12/22/2008] [Accepted: 12/23/2008] [Indexed: 10/21/2022]
Abstract
Gross deletions in the F9 gene are easily detected by routinely sequencing hemophilia B-affected men. Nevertheless, a carrier diagnosis proves difficult as the presence of a normal allele does not recognize the partial or complete loss of the F9 gene and may be challenging if no DNA sample from affected men is available. This work aimed to identify hemophilia carriers in 2 families in which gross deletions of the F9 gene could be expected. The indirect genetic study was not conclusive, and sequencing did not show genetic defects in family 1. A real-time polymerase chain reaction (RT-PCR) assay using SYBR Green revealed the deletion of a copy of exon 8 in 3 women, whereas the multiple ligation-dependent probe amplification (MLPA) assay showed the deletion of a copy of exons 7 and 8 in these 3 women. These studies enabled us not only to rule out a pregnant woman as a carrier but also to confirm a complete deletion of the gene in the patient from family 2 and the heterozygous state of his mother. The advantages that the MLPA method offers are the identification of a multiple exon deletion in the same assay and commonly used technology. The RT-PCR technology used involves standardizing and analyzing each exon independently.
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Casaña P, Martínez F, Cabrera N, Cid AR, Aznar JA. Founder haplotype associated with the factor VIII Asp1241Glu polymorphism in a cohort of mild hemophilia A patients. J Thromb Haemost 2008; 6:1428-30. [PMID: 18419741 DOI: 10.1111/j.1538-7836.2008.02983.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cid AR, Zorio E, Haya S, Zúñiga P, Rueda J, Casaña P, Cabrera N, Arnau MA, Aznar JA. Treatment in a haemophiliac A patient with paroxysmal atrial fibrillation and ischemic heart disease. Haemophilia 2008; 13:760-2. [PMID: 17973853 DOI: 10.1111/j.1365-2516.2007.01443.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cid AR, Casaña P, Cabrera N, Haya S, Cortina V, Aznar JA. Inhibitor development in one patient and laboratory discrepancies in several families with both mild haemophilia and Arg531Cys mutation. Haemophilia 2007; 13:206-8. [PMID: 17286776 DOI: 10.1111/j.1365-2516.2006.01422.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Certain mutations in mild haemophilia A have been associated with a greater risk of inhibitor development, especially when associated with intense treatment. We present a patient with both mild haemophilia A and Arg531Cys mutation, which developed lowtitre inhibitors and was not seen to be related to the intense substitute treatment. The inhibitor has a greater effect on the exogenous factor VIII, permiting an adequate response to treatment with desmopressin. A discrepancy exists in the factor VIII activity in this our patient and in the haemophiliacs of another two families with the same mutation when determination is performed with one-stage or chromogenic method.
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Affiliation(s)
- A R Cid
- Congenital Coagulopathy Unit, La Fe University Hospital, Valencia, Spain.
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Espinós C, Casaña P, Haya S, Cid AR, Aznar JA. Molecular analyses in hemophilia B families: identification of six new mutations in the factor IX gene. Haematologica 2003; 88:235-6. [PMID: 12604421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
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Aznar JA, Bonanad S, Montoro JM, Hurtado C, Cid AR, Soler MA, De Miguel A. Influence of methylene blue photoinactivation treatment on coagulation factors from fresh frozen plasma, cryoprecipitates and cryosupernatants. Vox Sang 2001; 79:156-60. [PMID: 11111234 DOI: 10.1159/000031234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study the influence of virus photoinactivation with methylene blue (MB) on the coagulation factors of fresh frozen plasma (FFP) and the corresponding cryoprecipitates and cryosupernatants derived from it. MATERIALS AND METHODS The photoinactivation procedure of the German Red Cross (Springe) was applied using Biomat (Grifols, Spain). Twenty isogroup pools of three plasma units were made from 60 U of FFP. The pools were split into three bags. One of them was photoinactivated, and pre- and postinactivation samples (MB-plasma) were obtained. The second bag was treated in the same way, followed by the preparation of MB-cryoprecipitate and MB-cryosupernatant. The third bag was not photoinactivated, and was processed in the same way to obtain control cryoprecipitate and cryosupernatant. The prothrombin time and activated partial thromboplastin time were analysed, as well as fibrinogen, factors (F) II, V, VII, VIII, IX, XI and XIII, antithrombin III, von Willebrand (vW) F:RCo, vWF:Ag and the multimeric structure of vWF. RESULTS In plasma, the proteins most sensitive to photoinactivation were fibrinogen, FV, FVIII, FIX and FXI (24, 32, 28, 23 and 27% loss, respectively). In the MB-cryoprecipitate, the losses were higher for FVIII (23%), moderate for fibrinogen, FXIII and vWF:RCo (18, 14 and 13%, respectively) and minimal (only 3%) for vWF:Ag. In MB-cryosupernatants, the losses were higher for FV (26%) and moderate for fibrinogen (16%), FIX (18%) and FXI (19%), as well as for FII and FXIII (15%). The multimeric structure of vWF was not modified in MB-plasma or in MB-cryoprecipitates. The supernatants (both MB treated as well as controls) showed an absence of multimers of very high and high molecular weight. CONCLUSIONS The quantitative and qualitative conservation of coagulation factors achieved in MB-plasma-derived products suggest that they are useful for the global replacement of coagulation factors and for deficiencies in FV and FXI. In countries lacking the economic resources to obtain virally inactivated concentrates, MB-cryoprecipitates could be useful in von Willebrand's disease and fibrinogen and FXIII deficiencies. MB-cryosupernatants could be employed in thrombotic thrombocytopenic purpura, in the correction of total or partial deficiencies of prothrombin complex factors and in specific deficiencies of FV and FXI.
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Affiliation(s)
- J A Aznar
- Unidad de Coagulopatias Congénitas, Hospital Universitario La Fe, Valencia, España.
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Aznar JA, Montoro JM, Cid AR. The above letter was sent to Aznar et al., and they offer the following reply. Transfusion 2001. [DOI: 10.1046/j.1537-2995.2001.4101151.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The use of recombinant factor VIIa (rFVIIa) is on the increase, not only to treat haemophilic patients with inhibitors, but also patients with other clotting disorders. However, the most appropriate method of monitoring this treatment remains a question that has yet to be resolved. We studied 24 plasma samples from patients receiving rFVIIa treatment (three had haemophilia A with inhibitors, and three a congenital FVII deficiency) and compared the results obtained from the FVII:C and FVIIa assays. Although a good correlation between the two methods was obtained (r = 0.91), the values of the FVII:C method were 1.63 higher than those of the FVIIa method, with a relatively wide margin in the interval of the FVII:C/FVIIa ratios obtained [95% confidence interval (CI) 1.38--1.88, range 0.68--3.68]. This interval became wider when we compared values of over 6 IU mL(-1), which led us to conclude that the two methods cannot be considered equivalent. As the FVIIa method specifically measures FVIIa, and FVII:C assay is known to have a wide interlaboratory variability, we believe that the FVIIa assay would be more suitable for the monitoring of rFVIIa treatment.
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Affiliation(s)
- A R Cid
- Unidad de Coagulopatías Congénitas, Hospital Universitario La Fe, Valencia, Spain
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Aznar JA, Montoro JM, Cid AR, Bonanad S, Hurtado C, Soler MA, De Miguel A. Clotting factors in cryoprecipitate and cryo-supernatant prepared from MB-treated fresh plasma. Transfusion 2000; 40:493. [PMID: 10773066 DOI: 10.1046/j.1537-2995.2000.40040493.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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de la Rubia J, López A, Arriaga F, Cid AR, Vicente AI, Marty ML, Sanz MA. Response to plasma exchange and steroids as combined therapy for patients with thrombotic thrombocytopenic purpura. Acta Haematol 1999; 102:12-6. [PMID: 10473882 DOI: 10.1159/000040961] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We describe our experience in the management of 11 consecutive patients with thrombotic thrombocytopenic purpura (TTP) treated with a combined therapy of plasma exchange (PE) and steroids. Nine patients (82%) achieved complete remission (CR) after a median of 6 rounds of PE (range 2-22). There were 3 early relapses managed in the same way as the initial episode. One patient relapsed 23 months after diagnosis achieving CR with standard therapy; another patient suffered several relapses, and splenectomy was performed after the last one. Three patients died, 2 of them with resistant disease 9 and 38 days after diagnosis, and the remaining one died due to AIDS-related complications while he was in CR. Eight patients are alive in CR with a median follow-up of 38 months (range 8-74). The combination of PE and steroids is a well-tolerated and effective treatment of TTP, but improvements in therapy are needed to manage refractory patients.
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Affiliation(s)
- J de la Rubia
- Haematology Department, University Hospital La Fe, Valencia, Spain.
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