1
|
Mokhtar G, Abdelbaky A, Adly A, Ezzat D, Abdel Hakeem G, Hassab H, Youssry I, Ragab I, Sherief LM, Zakaria M, Hesham M, Salama N, Salah N, Afifi RAA, El-Ashry R, Makkeyah S, Adolf S, Amer YS, Omar TEI, Bussel J, Abd El Raouf E, Atfy M, Ellaboudy M, Florez I. Egyptian Pediatric Guidelines for the Management of Children with Isolated Thrombocytopenia Using the Adapted ADAPTE Methodology-A Limited-Resource Country Perspective. Children (Basel) 2024; 11:452. [PMID: 38671669 PMCID: PMC11048986 DOI: 10.3390/children11040452] [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] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Thrombocytopenia is a prevalent presentation in childhood with a broad spectrum of etiologies, associated findings, and clinical outcomes. Establishing the cause of thrombocytopenia and its proper management have obvious clinical repercussions but may be challenging. This article provides an adaptation of the high-quality Clinical Practice Guidelines (CPGs) of pediatric thrombocytopenia management to suit Egypt's health care context. METHODS The Adapted ADAPTE methodology was used to identify the high-quality CPGs published between 2010 and 2020. An expert panel screened, assessed and reviewed the CPGs and formulated the adapted consensus recommendations based on the best available evidence. DISCUSSION The final CPG document provides consensus recommendations and implementation tools on the management of isolated thrombocytopenia in children and adolescents in Egypt. There is a scarcity of evidence to support recommendations for various management protocols. In general, complete clinical assessment, full blood count, and expert analysis of the peripheral blood smear are indicated at initial diagnosis to confirm a bleeding disorder, exclude secondary causes of thrombocytopenia and choose the type of work up required. The International Society of Hemostasis and thrombosis-Bleeding assessment tool (ISTH-SCC BAT) could be used for initial screening of bleeding manifestations. The diagnosis of immune thrombocytopenic purpura (ITP) is based principally on the exclusion of other causes of isolated thrombocytopenia. Future research should report the outcome of this adapted guideline and include cost-analysis evaluations.
Collapse
Affiliation(s)
- Galila Mokhtar
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Ashraf Abdelbaky
- Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
| | - Amira Adly
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Dina Ezzat
- Pediatric Hematology Unit, Pediatric Department, Beni-Suef University, Beni-Suef 62521, Egypt;
- Pediatric Department, October 6 University, Giza 12585, Egypt
| | - Gehan Abdel Hakeem
- Pediatric Hematology and Oncology Unit, Pediatric Department, Minia University, Minia 61519, Egypt;
| | - Hoda Hassab
- Pediatric Hematology and Oncology Unit, Pediatric Department, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt;
| | - Ilham Youssry
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt; (I.Y.); (N.S.); (R.A.A.A.); (E.A.E.R.)
| | - Iman Ragab
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Laila M. Sherief
- Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt; (L.M.S.); (M.Z.); (M.H.); (M.A.)
| | - Marwa Zakaria
- Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt; (L.M.S.); (M.Z.); (M.H.); (M.A.)
| | - Mervat Hesham
- Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt; (L.M.S.); (M.Z.); (M.H.); (M.A.)
| | - Niveen Salama
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt; (I.Y.); (N.S.); (R.A.A.A.); (E.A.E.R.)
| | - Nouran Salah
- Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
| | - Rasha A. A. Afifi
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt; (I.Y.); (N.S.); (R.A.A.A.); (E.A.E.R.)
| | - Rasha El-Ashry
- Pediatric Hematology and Oncology Unit, Pediatric Department, Mansoura University, Mansoura 35516, Egypt;
| | - Sara Makkeyah
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Sonia Adolf
- Pediatric, Hematology Department, Institute of Medical Research and Clinical Studies, National Research Center, Giza 1770, Egypt;
| | - Yasser S. Amer
- Pediatrics Department, Quality Management Department, King Saud University Medical City, Riyadh 11451, Saudi Arabia;
- Research Chair for Evidence Based Health Care and Knowledge Translation, King Saud University, Riyadh 11451, Saudi Arabia
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (FMRP-USP), Ribeirao Preto 14040-900, SP, Brazil
| | - Tarek E. I. Omar
- Pediatrics Department, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt;
| | - James Bussel
- Pediatrics Department, Well Cornell Medical College, New York, NY 10065, USA;
| | - Eman Abd El Raouf
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt; (I.Y.); (N.S.); (R.A.A.A.); (E.A.E.R.)
| | - Mervat Atfy
- Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt; (L.M.S.); (M.Z.); (M.H.); (M.A.)
| | - Mohamed Ellaboudy
- Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt; (G.M.); (A.A.); (I.R.); (S.M.); (M.E.)
| | - Ivan Florez
- Department of Pediatrics, University of Antioquia, Medellin 050010, Colombia;
| |
Collapse
|
2
|
Mokhtar G, Adly A, Baky AA, Ezzat D, Hakeem GA, Hassab H, Youssry I, Ragab I, Florez I, Sherief LM, El-Ekiaby M, Zakaria M, Hesham M, Shaheen N, Salama N, Salah N, Afifi RAA, El-Ashry R, Youssef S, Ragab S, Habib SA, Omar T, Amer Y, Wali Y, Makkeyah S. Transfusion of blood components in pediatric age groups: an evidence-based clinical practice guideline adapted for the use in Egypt using 'Adapted ADAPTE'. Ann Hematol 2024; 103:1373-1388. [PMID: 38388746 PMCID: PMC10940419 DOI: 10.1007/s00277-024-05657-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
Pediatric transfusion is a complex area of medicine covering a wide age range, from neonates to young adults. Compared to adult practice, there is a relative lack of high-quality research to inform evidence-based guidelines. We aimed to adapt the pre-existing high-quality practice guidelines for the transfusion of blood components in different pediatric age groups to be available for national use by general practitioners, pediatricians, and other health care professionals. The guideline panel included 17 key leaders from different Egyptian institutions. The panel used the Adapted ADAPTE methodology. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to the target context of use. The guideline covered all important aspects of the indications, dosing, and administration of packed red cells, platelets, and fresh frozen plasma. It also included transfusion in special situations, e.g., chronic hemolytic anemia and aplastic anemia, management of massive blood loss, malignancies, surgery, recommendations for safe transfusion practices, and recommendations for modifications of cellular blood components. The final version of the adapted clinical practice guideline (CPG) has been made after a thorough review by an external review panel and was guided by their official recommendations and modifications. A set of implementation tools included algorithms, tables, and flow charts to aid decision-making in practice. This adapted guideline serves as a tool for safe transfusion practices in different pediatric age groups.
Collapse
Affiliation(s)
- Galila Mokhtar
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Amira Adly
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Ashraf Abdel Baky
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Pediatrics, MTI University, Cairo, Egypt
- Department of Pediatrics, Armed Forces College of Medicine (AFCM), Cairo, Egypt
| | - Dina Ezzat
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Beni Suef University, Beni Suef, Egypt
| | - Gehan Abdel Hakeem
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Minia University, Minia, Egypt
| | - Hoda Hassab
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Alexandria University, Alexandria, Egypt
| | - Ilham Youssry
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Cairo University, Giza, Egypt
| | - Iman Ragab
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Ivan Florez
- Department of Pediatrics, University of Antioquia, Medellin, Colombia
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Laila M Sherief
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Magdy El-Ekiaby
- Department of Clinical Pathology and Transfusion Medicine, Shabrawishi Hospital, Cairo, Egypt
| | - Marwa Zakaria
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Mervat Hesham
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Naglaa Shaheen
- Pediatric Hematology Department, Misr Children's Hospital, Health Insurance Organization, Cairo, Egypt
| | - Niveen Salama
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Cairo University, Giza, Egypt
| | - Nouran Salah
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Rasha A A Afifi
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Cairo University, Giza, Egypt
| | - Rasha El-Ashry
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Mansoura University, Monsoura, Egypt
| | - Salwa Youssef
- Department of Clinical Pathology and Transfusion Medicine, Ain Shams University, Cairo, Egypt
| | - Seham Ragab
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Menoufia University, Menoufia, Egypt
| | - Sonia A Habib
- Pediatric Hematology and Oncology Unit, National Research Center, Giza, Egypt
| | - Tarek Omar
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yasser Amer
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
- Department of Pediatrics, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yasser Wali
- Pediatric Hematology/Oncology Unit, Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sara Makkeyah
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt.
| |
Collapse
|
3
|
Ali Mohamed Aboughonaim A, Naguib Ettaby A, Ibrahim El-Noueum K, Hassab H, Emara DM. Dual gradient echo in-phase and out of phase sequences in assessment of hepatic iron overload in patients with beta-thalassemia, would be better? Eur J Radiol 2022; 154:110412. [PMID: 35724580 DOI: 10.1016/j.ejrad.2022.110412] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracy of the dual gradient-echo (GRE) in- and out-of-phase sequences as a quantitative tool for hepatic iron overload in comparison with MRI R2* relaxometry in paediatric patients with beta-thalassemia. METHOD Sixty-three patients with beta-thalassemia major (transfusion-dependent) or beta-thalassemia intermedia (transfusion- and non-transfusion-dependent) were referred from the paediatric department (haematology unit) to the radiology department at a university hospital. The paediatrician conducted a clinical examination for the studied group, assessed their laboratory data, conducted R2* relaxometry and dual gradient echo sequences to calculate R2* and relative signal intensity index at the axial mid-section of the liver, and studied their correlation. A 1.5 Tesla MR scanner was used (Achieva; Philips Medical Systems, the Netherlands). Data were fed to the computer and analysed using the IBM SPSS software package version 20.0 (Armonk, NY: IBM Corp). The Kolmogorov-Smirnov test was used to verify the normality of distribution. The significance of the results was determined at the 5% level. The Chi-square, Fisher's exact correction, Pearson coefficient, and Bland-Altman tests were used. RESULTS Dual gradient-echo in- and out-of-phase sequences using visual assessment accurately assessed 93.65% of our patient group with hepatic iron overload. A significant correlation was found between the relative signal intensity index and hepatic MRI R2* relaxometry (p < 0.001, r = 0.861). CONCLUSIONS Dual gradient-echo in and out-of-phase sequences are good imaging tools for hepatic iron detection and quantification. These sequences showed good correlation with R2* relaxometry (r = 0.861, p < 0.001).
Collapse
Affiliation(s)
| | | | | | - Hoda Hassab
- Department of Pediatrics (hematology unit), Faculty of medicine, Alexandria University, Egypt
| | - Doaa M Emara
- Department of radiodiagnosis, Faculty of medicine, Alexandria University, Egypt
| |
Collapse
|
4
|
Achebe M, Hassab H, Alkindi S, Brown C, Telfer P, Biemond B, Gordeuk V, Lipato T, Alfa Cissé O, Darson F, Tonda M, Gray S, Howard J. Sécurité et efficacité à long terme du voxelotor chez des patients atteints de drépanocytose : résultats d’une étude d’extension en ouvert de l’essai de phase 3 HOPE. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.136] [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: 12/01/2022]
|
5
|
Elalfy M, Elghamry I, Hassab H, Elalfy O, Andrawes N, El-Ekiaby M. Low-dose immune tolerance induction therapy in children of Arab descent with severe haemophilia A, high inhibitor titres and poor prognostic factors for immune tolerance induction treatment success. Haemophilia 2021; 28:65-72. [PMID: 34797008 PMCID: PMC9299496 DOI: 10.1111/hae.14456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/22/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Immune Tolerance Induction (ITI) is the first-choice therapy to eradicate Factor VIII (FVIII) neutralizing antibodies in patients with haemophilia A (HA). There is limited published data on ITI from East Mediterranean countries. AIM To assess the effectiveness of a low-dose ITI regimen to eradicate FVIII neutralizing antibodies in children with severe HA and high-titre inhibitors. METHODS A prospective, single-arm study was conducted in children with HA (FVIII < 1 IU/dl), high-titre inhibitors and poor prognostic factors for successful ITI. Patients were treated with ∼50 IU/kg plasma-derived FVIII containing von Willebrand factor (pdFVIII/VWF) concentrate (Koate-DVI, Grifols) three times a week. Time to achieve tolerance, total and partial success were analysed after ITI. Annual bleeding rate (ABR), number of target joints, FVIII recovery and school absence were compared before and after ITI. RESULTS Twenty patients with median (range) age of 6.2 (3-12) years and pre-ITI inhibitor titre of 36.5 (12-169) BU were enrolled. ITI lasted ≤12 months (early tolerization) in 45% of patients. Median follow-up was 12 months (3-22) and total response rate was 80% (60% total success; 20% partial success). Patients with two and three poor prognosis factors achieved overall success rate of 60% and 50%, respectively. ABR, target joints and school absence were reduced after ITI by 60%, 50% and 44.1%, respectively. In successful ITI tolerized patients, FVIII recovery was 90 (60-100)%. CONCLUSION A low-dose ITI therapy using a pdFVIII/VWF concentrate achieved at least partial tolerance in 80% of patients, and reduced annual bleeds in children with high inhibitor titres and at least one poor prognosis factor for ITI treatment success.
Collapse
Affiliation(s)
- Mohsen Elalfy
- Hemophilia Care Centre, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Islam Elghamry
- Hemophilia Care Centre, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hoda Hassab
- Hemophilia Care Centre, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Omar Elalfy
- National Research Centre, Complementary Medicine, Cairo, Egypt
| | - Nevine Andrawes
- Hemophilia Care Centre, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Magdy El-Ekiaby
- Hematology Unit, Blood Transfusion Centre, Shabrawishi Hospital, Giza, Egypt
| |
Collapse
|
6
|
Howard J, Ataga KI, Brown RC, Achebe M, Nduba V, El-Beshlawy A, Hassab H, Agodoa I, Tonda M, Gray S, Lehrer-Graiwer J, Vichinsky E. Voxelotor in adolescents and adults with sickle cell disease (HOPE): long-term follow-up results of an international, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Haematol 2021; 8:e323-e333. [PMID: 33838113 DOI: 10.1016/s2352-3026(21)00059-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND For decades, patients with sickle cell disease have had only a limited number of therapies available. In 2019, voxelotor (1500 mg), an oral once-daily sickle haemoglobin polymerisation inhibitor, was approved in the USA for the treatment of sickle cell disease in patients aged 12 years and older on the basis of HOPE trial data. To further describe the applicability of voxelotor as a treatment for this chronic illness, we report the long-term efficacy and safety of this drug at 72 weeks of treatment; the conclusion of the placebo-controlled HOPE trial. METHODS HOPE is an international, randomised, double-blind, placebo-controlled, phase 3 trial done at 60 clinical sites in Canada, Egypt, France, Italy, Jamaica, Kenya, Lebanon, Netherlands, Oman, Turkey, the USA, and the UK. Patients (aged 12-65 years) with confirmed sickle cell disease, a haemoglobin concentration of 5·5-10·5 g/dL at enrolment, and who had between one and ten vaso-occlusive crisis events in the previous 12 months were enrolled. Patients receiving regularly scheduled transfusion therapy, who had received a transfusion in the previous 60 days, or who had been admitted to hospital for a vaso-occlusive crisis in the previous 14 days were excluded. Patients were randomly assigned (1:1:1) to receive either once-daily oral voxelotor 1500 mg, voxelotor 900 mg, or placebo for 72 weeks. Randomisation was done centrally by use of an interactive web response system, stratified by baseline hydroxyurea use (yes vs no), age group (adolescents [12 to <18 years] vs adults [18 to 65 years]), and geographic region (North America vs Europe vs other). The primary endpoint (already reported) was the proportion of patients who achieved a haemoglobin response at week 24. In this final analysis, we report prespecified long-term efficacy assessments by intention to treat, including changes in haemoglobin concentrations from baseline to week 72, changes in the concentration of haemolysis markers (absolute and percentage reticulocytes, indirect bilirubin concentrations, and lactate dehydrogenase concentrations) from baseline to week 72, the annualised incidence of vaso-occlusive crises, and patient functioning, as assessed with the Clinical Global Impression of Change (CGI-C) scale. Safety was assessed in patients who received at least one dose of treatment (modified intention-to-treat population). This trial is registered with ClinicalTrials.gov, NCT03036813. FINDINGS Between Dec 5, 2016, and May 3, 2018, 449 patients were screened, of whom 274 were randomly assigned to the voxelotor 1500 mg group (n=90), the voxelotor 900 mg group (n=92), or the placebo group (n=92). At week 72, the adjusted mean change in haemoglobin concentration from baseline was 1·0 g/dL (95% CI 0·7 to -1·3) in the voxelotor 1500 mg group, 0·5 g/dL (0·3 to -0·8) in the voxelotor 900 mg group, and 0·0 g/dL (-0·3 to 0·3) in the placebo group, with a significant difference observed between the voxelotor 1500 mg group and the placebo group (p<0·0001), and between the voxelotor 900 mg group and the placebo group (p=0·014). Significant improvements in markers of haemolysis, as assessed by the difference in adjusted mean percentage change from baseline at week 72 versus placebo, were observed in the voxelotor 1500 mg group in indirect bilirubin concentrations (-26·6% [95% CI -40·2 to -12·9]) and percentage of reticulocytes (-18·6% [-33·9 to -3·3]). The proportion of patients in the voxelotor 1500 mg group who were rated as "moderately improved" or "very much improved" at week 72 with the CGI-C was significantly greater than in the placebo group (39 [74%] of 53 vs 24 [47%] of 51; p=0·0057). Serious adverse events unrelated to sickle cell disease were reported in 25 (28%) of 88 patients in the voxelotor 1500 mg group, 20 (22%) of 92 patients in the voxelotor 900 mg group, and 23 (25%) of 91 patients in the placebo group. Grade 3 or 4 adverse events were infrequent (ie, occurred in <10% of patients); anaemia occurred in five or more patients (two [2%] patients in the voxelotor 1500 mg group, seven [8%] patients in the voxelotor 900 mg group, and three [3%] patients in the placebo group). Of all 274 patients, six (2%) deaths occurred during the study (two deaths in each treatment group), all of which were judged as unrelated to treatment. INTERPRETATION Voxelotor 1500 mg resulted in rapid and durable improvements in haemoglobin concentrations maintained over 72 weeks and has potential to address the substantial morbidity associated with haemolytic anaemia in sickle cell disease. FUNDING Global Blood Therapeutics.
Collapse
Affiliation(s)
- Jo Howard
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Kenneth I Ataga
- University of Tennessee Health Science Center at Memphis, Memphis, TN, USA
| | - Robert C Brown
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, and Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Maureen Achebe
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Amal El-Beshlawy
- Department of Pediatric Hematology, Cairo University, Cairo, Egypt
| | - Hoda Hassab
- Department of Pediatrics and Clinical Research Center, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Irene Agodoa
- Global Blood Therapeutics, South San Francisco, CA, USA
| | | | - Sarah Gray
- Global Blood Therapeutics, South San Francisco, CA, USA
| | | | | |
Collapse
|
7
|
Abohadida R, Essawy M, Hassab H, Abd-Elkader W, Sherif H. Effect of Acupressure versus Ginger on Gastrointestinal Side-Effects of Chemotherapy on Children with Leukemia. Alexandria Scientific Nursing Journal 2020; 22:27-48. [DOI: 10.21608/asalexu.2020.206111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
8
|
Maggio A, Kattamis A, Felisi M, Reggiardo G, El-Beshlawy A, Bejaoui M, Sherief L, Christou S, Cosmi C, Della Pasqua O, Del Vecchio GC, Filosa A, Cuccia L, Hassab H, Kreka M, Origa R, Putti MC, Spino M, Telfer P, Tempesta B, Vitrano A, Tsang YC, Zaka A, Tricta F, Bonifazi D, Ceci A. Evaluation of the efficacy and safety of deferiprone compared with deferasirox in paediatric patients with transfusion-dependent haemoglobinopathies (DEEP-2): a multicentre, randomised, open-label, non-inferiority, phase 3 trial. Lancet Haematol 2020; 7:e469-e478. [PMID: 32470438 DOI: 10.1016/s2352-3026(20)30100-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transfusion-dependent haemoglobinopathies require lifelong iron chelation therapy with one of the three iron chelators (deferiprone, deferasirox, or deferoxamine). Deferasirox and deferiprone are the only two oral chelators used in adult patients with transfusion-dependent haemoglobinopathies. To our knowledge, there are no randomised clinical trials comparing deferiprone, a less expensive iron chelator, with deferasirox in paediatric patients. We aimed to show the non-inferiority of deferiprone versus deferasirox. METHODS DEEP-2 was a phase 3, multicentre, randomised trial in paediatric patients (aged 1 month to 18 years) with transfusion-dependent haemoglobinopathies. The study was done in 21 research hospitals and universities in Italy, Egypt, Greece, Albania, Cyprus, Tunisia, and the UK. Participants were receiving at least 150 mL/kg per year of red blood cells for the past 2 years at the time of enrolment, and were receiving deferoxamine (<100 mg/kg per day) or deferasirox (<40 mg/kg per day; deferasirox is not registered for use in children aged <2 years so only deferoxamine was being used in these patients). Any previous chelation treatment was permitted with a 7-day washout period. Patients were randomly assigned 1:1 to receive orally administered daily deferiprone (75-100 mg/kg per day) or daily deferasirox (20-40 mg/kg per day) administered as dispersible tablets, both with dose adjustment for 12 months, stratified by age (<10 years and ≥10 years) and balanced by country. The primary efficacy endpoint was based on predefined success criteria for changes in serum ferritin concentration (all patients) and cardiac MRI T2-star (T2*; patients aged >10 years) to show non-inferiority of deferiprone versus deferasirox in the per-protocol population, defined as all randomly assigned patients who received the study drugs and had available data for both variables at baseline and after 1 year of treatment, without major protocol violations. Non-inferiority was based on the two-sided 95% CI of the difference in the proportion of patients with treatment success between the two groups and was shown if the lower limit of the two-sided 95% CI was greater than -12·5%. Safety was assessed in all patients who received at least one dose of study drug. This study is registered with EudraCT, 2012-000353-31, and ClinicalTrials.gov, NCT01825512. FINDINGS 435 patients were enrolled between March 17, 2014, and June 16, 2016, 393 of whom were randomly assigned to a treatment group (194 to the deferiprone group; 199 to the deferasirox group). 352 (90%) of 390 patients had β-thalassaemia major, 27 (7%) had sickle cell disease, five (1%) had thalassodrepanocytosis, and six (2%) had other haemoglobinopathies. Median follow-up was 379 days (IQR 294-392) for deferiprone and 381 days (350-392) for deferasirox. Non-inferiority of deferiprone versus deferasirox was established (treatment success in 69 [55·2%] of 125 patients assigned deferiprone with primary composite efficacy endpoint data available at baseline and 1 year vs 80 [54·8%] of 146 assigned deferasirox, difference 0·4%; 95% CI -11·9 to 12·6). No significant difference between the groups was shown in the occurrence of serious and drug-related adverse events. Three (2%) cases of reversible agranulocytosis occurred in the 193 patients in the safety analysis in the deferiprone group and two (1%) cases of reversible renal and urinary disorders (one case of each) occurred in the 197 patients in the deferasirox group. Compliance was similar between treatment groups: 183 (95%) of 193 patients in the deferiprone group versus 192 (97%) of 197 patients in the deferisirox group. INTERPRETATION In paediatric patients with transfusion-dependent haemoglobinopathies, deferiprone was effective and safe in inducing control of iron overload during 12 months of treatment. Considering the need for availability of more chelation treatments in paediatric populations, deferiprone offers a valuable treatment option for this age group. FUNDING EU Seventh Framework Programme.
Collapse
Affiliation(s)
- Aurelio Maggio
- Department of Hematology and Rare Diseases, V Cervello, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
| | - Antonis Kattamis
- First Department of Pediatrics, National and Kapodistriam University of Athens, Athens, Greece
| | - Mariagrazia Felisi
- Consorzio per Valutazioni Biologiche e Farmacologiche, Bari-Pavia, Italy
| | | | | | - Mohamed Bejaoui
- Pediatrics and Bone Marrow Transplantation Centre, Tunis, Tunisia
| | - Laila Sherief
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Carlo Cosmi
- Clinica Pediatrica, Azienda Ospedaliero Universitaria (AOU) Sassari, Sassari, Italy
| | - Oscar Della Pasqua
- Clinical Pharmacology and Therapeutics Group, University College London, London, UK
| | | | - Aldo Filosa
- UOSD Malattie rare del globulo rosso, AORN A Cardarelli, Napoli, Italy
| | - Liana Cuccia
- UOC Ematologia con Talassemia, Dipartimento di Medicina, AO Civico Di Cristina-Benfratelli, Palermo, Italy
| | - Hoda Hassab
- Department of Pediatrics and Clinical Research Center, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Manika Kreka
- Pediatrics Department, University Hospital Center Mother Teresa, Tirana, Albania
| | - Raffaella Origa
- DH Talassemia, Ospedale Pediatrico Microcitemico A CAO, AO G Brotzu, Cagliari, Italy
| | - Maria Caterina Putti
- Department of Women's and Child's Health (DSDB), University Hospital, Padova, Italy
| | | | - Paul Telfer
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Bianca Tempesta
- Consorzio per Valutazioni Biologiche e Farmacologiche, Bari-Pavia, Italy
| | - Angela Vitrano
- Department of Hematology and Rare Diseases, V Cervello, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | - Ariana Zaka
- Center of Thalassemia, Hospital Ihsan Cabej, Lushnje, Albania
| | | | - Donato Bonifazi
- Consorzio per Valutazioni Biologiche e Farmacologiche, Bari-Pavia, Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano, Italy
| |
Collapse
|
9
|
Mikhael NL, Seif H Gendi MA, Hassab H, Megahed EA. Evaluation of multiplexed biomarkers in assessment of CSF infiltration in pediatric acute lymphoblastic leukemia. Int J Hematol Oncol 2019; 8:IJH22. [PMID: 31850146 PMCID: PMC6912847 DOI: 10.2217/ijh-2019-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 12/23/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) is a very common pediatric malignancy with high survival rates. The course of treatment is modified according to the occurrence of central nervous system (CNS) disease. Aim: To relate serum and cerebrospinal fluid levels of five biomarkers (matrix metalloprotienase 9, CCL-2, sVCAM-1, IFN-γ and inducible protein 10) at diagnosis to the development of CNS infiltration. Methods: The present study was carried on 64 children with ALL and 20 controls. Multiplexed cytokines were measured by Luminex technology (Matrix metalloprotienase 9, CCL-2, sVCAM-1, IFN-γ and inducible protein 10). Results: Significantly higher sMMP-9 and lower sCCL2 were found in patients who developed CNS leukemia. Conclusion: Serum multiplexed parameters at diagnosis of childhood ALL may predict of development of CNS leukemia.
Collapse
Affiliation(s)
- Neveen L Mikhael
- Department of Clinical & Chemical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Myriam Abo Seif H Gendi
- Department of Clinical & Chemical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hoda Hassab
- Department of Pediatrics Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Elshaymaa A Megahed
- Department of Clinical & Chemical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| |
Collapse
|
10
|
Vichinsky E, Hoppe CC, Ataga KI, Ware RE, Nduba V, El-Beshlawy A, Hassab H, Achebe MM, Alkindi S, Brown RC, Diuguid DL, Telfer P, Tsitsikas DA, Elghandour A, Gordeuk VR, Kanter J, Abboud MR, Lehrer-Graiwer J, Tonda M, Intondi A, Tong B, Howard J. A Phase 3 Randomized Trial of Voxelotor in Sickle Cell Disease. N Engl J Med 2019; 381:509-519. [PMID: 31199090 DOI: 10.1056/nejmoa1903212] [Citation(s) in RCA: 343] [Impact Index Per Article: 68.6] [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 Deoxygenated sickle hemoglobin (HbS) polymerization drives the pathophysiology of sickle cell disease. Therefore, direct inhibition of HbS polymerization has potential to favorably modify disease outcomes. Voxelotor is an HbS polymerization inhibitor. METHODS In a multicenter, phase 3, double-blind, randomized, placebo-controlled trial, we compared the efficacy and safety of two dose levels of voxelotor (1500 mg and 900 mg, administered orally once daily) with placebo in persons with sickle cell disease. The primary end point was the percentage of participants who had a hemoglobin response, which was defined as an increase of more than 1.0 g per deciliter from baseline at week 24 in the intention-to-treat analysis. RESULTS A total of 274 participants were randomly assigned in a 1:1:1 ratio to receive a once-daily oral dose of 1500 mg of voxelotor, 900 mg of voxelotor, or placebo. Most participants had sickle cell anemia (homozygous hemoglobin S or hemoglobin Sβ0-thalassemia), and approximately two thirds were receiving hydroxyurea at baseline. In the intention-to-treat analysis, a significantly higher percentage of participants had a hemoglobin response in the 1500-mg voxelotor group (51%; 95% confidence interval [CI], 41 to 61) than in the placebo group (7%; 95% CI, 1 to 12). Anemia worsened between baseline and week 24 in fewer participants in each voxelotor dose group than in those receiving placebo. At week 24, the 1500-mg voxelotor group had significantly greater reductions from baseline in the indirect bilirubin level and percentage of reticulocytes than the placebo group. The percentage of participants with an adverse event that occurred or worsened during the treatment period was similar across the trial groups. Adverse events of at least grade 3 occurred in 26% of the participants in the 1500-mg voxelotor group, 23% in the 900-mg voxelotor group, and 26% in the placebo group. Most adverse events were not related to the trial drug or placebo, as determined by the investigators. CONCLUSIONS In this phase 3 randomized, placebo-controlled trial involving participants with sickle cell disease, voxelotor significantly increased hemoglobin levels and reduced markers of hemolysis. These findings are consistent with inhibition of HbS polymerization and indicate a disease-modifying potential. (Funded by Global Blood Therapeutics; HOPE ClinicalTrials.gov number, NCT03036813.).
Collapse
Affiliation(s)
- Elliott Vichinsky
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Carolyn C Hoppe
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Kenneth I Ataga
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Russell E Ware
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Videlis Nduba
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Amal El-Beshlawy
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Hoda Hassab
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Maureen M Achebe
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Salam Alkindi
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - R Clark Brown
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - David L Diuguid
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Paul Telfer
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Dimitris A Tsitsikas
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Ashraf Elghandour
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Victor R Gordeuk
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Julie Kanter
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Miguel R Abboud
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Joshua Lehrer-Graiwer
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Margaret Tonda
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Allison Intondi
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Barbara Tong
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Jo Howard
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| |
Collapse
|
11
|
Kanter J, Heath LE, Knorr J, Agbenyega ET, Colombatti R, Dampier C, Hassab H, Manwani D, Robitaille N, Brown PB, Jakubowski JA, Yao S, Hoppe C. Novel findings from the multinational DOVE study on geographic and age-related differences in pain perception and analgesic usage in children with sickle cell anaemia. Br J Haematol 2018; 184:1058-1061. [PMID: 29676449 DOI: 10.1111/bjh.15250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Julie Kanter
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Jack Knorr
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Raffaella Colombatti
- Azienda Ospedaliera-Università di Padova, Clinica di Oncoematologia Pediatrica Via Giustiniani, Padova, Italy
| | - Carlton Dampier
- Emory University, AFLAC Cancer and Blood Disorders Center, Atlanta, GA, USA
| | - Hoda Hassab
- Paediatric Department and Clinical Research Center, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Deepa Manwani
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nancy Robitaille
- Division of Hematology-Oncology, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
| | | | | | - Suqin Yao
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Carolyn Hoppe
- Department of Hematology-Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| |
Collapse
|
12
|
Abstract
Altered expression or function of adhesion molecules on leukaemic blasts may contribute to the evolution and biological behaviour of acute leukaemia. This work studies the expression of CD54 and CD62L by lymphoid cells and the serum level of the shed form of L-selectin (sL-selectin) in children with acute lymphoblastic leukaemia (ALL) at initial diagnosis and after first remission, and their relationship to disease activity and subtype. The study is conducted on 20 children (age range 2-10 years) newly diagnosed with ALL and admitted to Alexandria University Children's Hospital. Ten apparently healthy children of matched age and sex serve as a control group. Expression of CD54 and CD62L on mononuclear cells is detected by monoclonal antibodies using flow cytometry. Serum sL-selectin is measured by enzyme-linked immunosorbent assay (ELISA). B-cell ALL was the most common subtype (45%), followed by T-ALL (35%) and C-ALL (20%). CD54 and CD62L mean cellular expression, as well as serum sL-selectin level, were significantly higher at diagnosis than both after remission and in the control group. Univariate analysis showed that the presence of mediastinal mass, high leucocyte count, central nervous system involvement and low CD54 were significant predictors of mortality in children with ALL.
Collapse
Affiliation(s)
- F M Hafez
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Egypt
| | | | | | | |
Collapse
|
13
|
Mourad Z, Hassab H, Younan D, Abdo A. Human leucocyte antigen alloimmunisation in repeatedly transfused thalassemic Egyptian children and its relation to febrile non-haemolytic transfusion reactions. Transfus Med 2015; 25:380-4. [PMID: 26578338 DOI: 10.1111/tme.12261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 06/06/2015] [Accepted: 10/24/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To document the incidence of lymphocytotoxic antibodies (LCA) in chronically transfused children with β thalassemia major and the relationship between alloimmunisation and febrile non-haemolytic transfusion reactions. We also compared the effect of leucoreduced-packed red blood cells (RBCs) by bed-side filtration and washed RBCs in preventing FNHTRs and in inducing haemoglobin rise. BACKGROUND Alloimmunisation to human leucocytic antigens is one of the common complications of transfusions, particularly in chronically transfused patients as those with thalassemia major, a common disease in Northern Egypt. METHODS/MATERIALS LCA were screened for in 45 chronically transfused β thalassemia major children (group I), 20 splenectomised ones (group II) and 20 healthy controls (group III), using qualitative lymphocytotoxic antibody (LCA) enzyme-linked immunosorbent assay (ELISA) kit. RESULTS Nine out of 65 thalassemic children (∼14%) were positive for LCA antibodies. Frequency of transfusions and LCA positivity were significantly higher in group I than group II (p = 0.036 and 0.014). There was no statistically significant difference between LCA positive and negative cases regarding age of starting transfusion, frequency of transfusions or FNHTRs. There was no statistically significant difference between washed and filtered RBCs in reducing FNHTRs (p = 1.000) and in inducing haemoglobin rise in positive LCA cases (p = 0.409). CONCLUSION Human leukocyte antigen (HLA) alloimmunisation was only 14% in the children with β thalassemia major we studied. Surprisingly FNHTRs were not more common in those with HLA antibodies. Splenectomy plays a role in reducing the frequency of transfusion and HLA alloimmunisation. Washed and filtered RBCs are comparable in reducing FNHTRs and in inducing haemoglobin rise.
Collapse
Affiliation(s)
- Z Mourad
- Clinical Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - H Hassab
- Pediatric Hematology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - D Younan
- Clinical Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - A Abdo
- Clinical Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| |
Collapse
|
14
|
Azouz H, Hassab H, Abdallah M, Elghany H. Neurophysiologic Evaluation of Children with Beta-Thalassemia Major. J Pediatr Neurol 2015. [DOI: 10.1055/s-0035-1557148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Hanan Azouz
- Department of Pediatric Neurology, Faculty of Medicine, Alexandria University, Egypt
| | - Hoda Hassab
- Department of Pediatric Hematology, Faculty of Medicine, Alexandria University, Egypt
| | - Marwa Abdallah
- Department of Pediatric Neurology, Faculty of Medicine, Alexandria University, Egypt
| | - Hayam Elghany
- Department of Physical Medicine, Rheumatology Rehabilitation Faculty of Medicine, Alexandria University, Egypt
| |
Collapse
|
15
|
Gwili N, Abdel-Hadi M, Nour-Eldin A, Hassab H, Saad ElDin Y, Fadel S, Mashali N. Lymphadenopathy in a Series of Egyptian Pediatric Patients and the Role of Pathology in the Diagnostic Workup. Pediatr Dev Pathol 2014:14-05-1480-OA.1. [PMID: 25075446 DOI: 10.2350/14-05-1480-oa.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Assessment of lymphadenopathy in children represents a diagnostic challenge because of the extensive differential diagnoses including reactive and malignant conditions. Knowledge of the etiologic pattern of lymphadenopathy in a given geographical region is essential for making a confident diagnosis or suspecting a disease. Hence, the present study was carried out to identify different etiologies of lymphadenopathy in children in our region, and assess parameters commonly associated with malignancy, with an emphasis on the role of pathology in the diagnostic workup. One hundred and twenty patients aged one month to 18 years were included in the study. They were sorted into neoplastic and non-neoplastic (Infectious and non-infectious). In only 56 patients, biopsy, whether fine needle aspiration cytology (FNAC), core needle or excision biopsy, was essential to reach the final diagnosis. Sensitivity of FNAC in the differentiation between neoplastic and non-neoplastic lymphadenopathy was 92.3%, specificity 90.0%, with a diagnostic accuracy of 91.3%. We concluded that malignancy should be suspected in the following conditions: presence of abdominal or multiple symptoms, symptoms duration of 1-6 months, generalized lymphadenopathy, multiple groups of lymph node (LN) involved, LN size > 2 cm, amalgamated, hard, fixed and non-tender LNs, certain abnormal CBC findings, blast cells in blood film and elevated LDH level. In such cases, LN biopsy is highly recommended. A final diagnosis was achieved after integrating information from history and clinical findings with those of the laboratory, radiological, pathological and microbiological findings. Accordingly, an algorithm for primary diagnostic evaluation of children with lymphadenopathy is suggested.
Collapse
Affiliation(s)
- Noha Gwili
- 1 Alexandria University, Faculty of Medicine, Pathology
| | | | | | - Hoda Hassab
- 4 Alexandria University, Faculty of Medicine, Pediatrics
| | | | - Shady Fadel
- 6 Alexandria University, Faculty of Medicine, Pediatric Oncology
| | - Nagwa Mashali
- 7 Alexandria University, Faculty of Medicine, Pathology
| |
Collapse
|
16
|
El Nadeef M, Hassab H, Al Hosani E. National survey of the oral health of 5-year-old children in the United Arab Emirates. East Mediterr Health J 2010. [DOI: 10.26719/2010.16.1.51] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
17
|
El-Nadeef MAI, Hassab H, Al-Hosani E. National survey of the oral health of 5-year-old children in the United Arab Emirates. East Mediterr Health J 2010; 16:51-55. [PMID: 20214158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A total of 1340 5-year-old children were examined as part of the first national survey of the oral health of children in the United Arab Emirates. The objective was to determine dental caries status and compare variations in caries experience in all 9 medical districts. Sampling and examination for caries was done following World Health Organization guidelines and criteria. Only 17% of the children were caries-free. The mean decayed/missing/filled teeth (dmft) index was 5.1, ranging from 3.8 in Ajman to 6.6 in Dubai. More than half (52%) had > 4 dmf teeth. Overall, caries is highly prevalent in the primary dentition of 5-year-old children and mostly untreated.
Collapse
Affiliation(s)
- M A I El-Nadeef
- Preventive Dentistry Section, Ministry of Health, Dubai, United Arab Emirates.
| | | | | |
Collapse
|
18
|
Elalfy M, Elbarbary N, Khaddah N, Abdelwahab M, El Rashidy F, Hassab H, Al-Tonbary Y. Intracranial hemorrhage in acute and chronic childhood immune thrombocytopenic purpura over a ten-year period: an Egyptian multicenter study. Acta Haematol 2009; 123:59-63. [PMID: 19955713 DOI: 10.1159/000262293] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 09/30/2009] [Indexed: 11/19/2022]
Abstract
Intracranial hemorrhage (ICH) is a rare but major cause of death in immune thrombocytopenic purpura (ITP). The authors reviewed data of 1,840 patient with ITP, from 5 pediatric hematology centers in Egypt from 1997 to 2007, to study the incidence and risk factors of ICH. Ten cases of ICH were identified with a median age at presentation of 7.5 years; 4 patients had acute ITP, 2 persistent and 4 chronic. The platelet count was <10 x 10(9)/l in 7 cases, and only 1 patient had a history of head trauma. Seven children were on treatment prior to or at the time of occurrence of ICH and all were treated by pharmacotherapy. Two children died shortly afterwards due to late referral to a specialized center. Our results suggest that treatment does not prevent ICH and that it can occur at any time during the course of the disease. Delayed referral can be considered a risk factor for unfavorable outcome of ICH, highlighting the importance of teaching sessions for patients and their parents to minimize subsequent morbidity and mortality of ICH in children with ITP.
Collapse
Affiliation(s)
- Mohsen Elalfy
- Department of Paediatric Haematology, Ain Shams University Cairo, 2 Sayed Zakaria Khalil, Morbah 1153, No 2 Elalfy, Cairo, Egypt.
| | | | | | | | | | | | | |
Collapse
|
19
|
El Nadeef M, Al Hussani E, Hassab H, Arab I. National survey of the oral health of 12- and 15-year-old schoolchildren in the United Arab Emirates. East Mediterr Health J 2009. [DOI: 10.26719/2009.15.4.993] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
20
|
El-Nadeef MAI, Al Hussani E, Hassab H, Arab IA. National survey of the oral health of 12- and 15-year-old schoolchildren in the United Arab Emirates. East Mediterr Health J 2009; 15:993-1004. [PMID: 20187552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This paper describes the first national survey of oral health in the United Arab Emirates (UAE). Using WHO criteria, dental caries and fluorosis were recorded in 2651 schoolchildren aged 12 and 15 years, and periodontal disease in those aged 15 years. The prevalence of dental caries in the permanent teeth of 12-year-olds was 54%; the mean DMFT (number of decayed, missing or filled permanent teeth) per child was 1.6. The prevalence of dental caries in 15-year-olds was 65% and the mean DMFT was 2.5. For the UAE as a whole, 70% of 12-year-old schoolchildren had no dental fluorosis and 37% of 15-year-olds had healthy periodontal tissues.
Collapse
Affiliation(s)
- M A I El-Nadeef
- Preventive Dentistry Section, Ministry of Health, Dubai, United Arab Emirates.
| | | | | | | |
Collapse
|
21
|
Guiziry DEL, El GW, Farahat N, Hassab H. Phenotypic analysis of bone marrow lymphocytes from children with acute thrombocytopenic purpura. Egypt J Immunol 2005; 12:9-14. [PMID: 16734134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Hematogones are benign immature B cells that commonly populate the bone marrow of children. Their presence has been noted to interfere with the flow-cytometric analysis of acute lymphoblastic leukemia (ALL), because their immunophenotype is similar to B-precursor cell lymphoblasts. Immune-mediated thrombocytopenia is a clinical condition characterized by increased platelet destruction due to sensitization of platelets by autoantibodies. The aim of this study was to determine the incidence and clinical impact of bone marrow hematogones in cases of acute immune thrombocytopenic purpura (ITP) among children. This was done by immunophenotyping of bone marrow lymphocytes of ITP cases and controls and follow up of cases. This study was done on 25 cases of ITP, 12 females and 13 males, their age ranged from 2 to 13 years. A control group was included in the study, 15 cases of apparently healthy children with matching age and sex taken from among bone marrow donors. Cases and controls were subjected to bone marrow lymphocyte immunophenotyping with flow-cytometry to verify the presence of hematogones. A statistically significant increase in the percentage of hematogones was demonstrated in their bone marrows. An increased percentage of CD10+ lymphocytes was demonstrated; with a mean of 18+/-15.2%, CD19+ with a mean of 27+/-16.3% and CD34+ with a mean of 3.7+/-3.2%. No correlation was found between the percentage of hematogones and peripheral platelet count or bone marrow lymphocytic count. In conclusion, there is an increase in the bone marrow hematogones in ITP cases in comparison to normal controls. This could be the sequence of an immunological response to the cause which determined the disease, or the regeneration of the stem cell compartment following transient damage.
Collapse
Affiliation(s)
- Dalai E L Guiziry
- Department of Clinical Pathology, Alexandria University, Alexandria, Egypt
| | | | | | | |
Collapse
|
22
|
Rizk EA, El-Gendy WM, Hassab H, El-Madboully L. Granulocyte-macrophage colony-stimulating factor (GM-CSF) in children with acute immune thrombocytopenic purpura. Med Sci Monit 2004; 10:CR330-5. [PMID: 15232508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2003] [Accepted: 10/22/2003] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The purpose of our study was to assess the serum level of GM-CSF in children with acute ITP and its correlation with clinical parameters and with the level of platelet-associated immunoglobulins. MATERIAL/METHODS Thirty children with acute ITP were selected from the inpatient department at Alexandria University Children's Hospital at El Shatby. Ten apparently healthy children served as controls. ITP Patients were divided according to platelet count into those with platelet count >20,000/ul and cases with platelet counts <20,000/ul. Serum GM-CSF was measured by the ELISA technique. Total IgG was measured by radial immunodiffusion plates, and PAIgG was detected directly by flow cytometry. RESULTS Total IgG showed significant elevation in ITP patients as compared to controls (t=2.748, P<0.05), but no correlation was detected between platelet antibodies and total IgG (r=-0.140, P=0.460). 86% of the patients had elevated platelet-associated immunoglobulin (PAIgG). No correlation between PAIgG and platelet count was detected (r=-0.072, P=0.72). Serum GM-CSF was significantly higher in ITP patients than controls (t=3.757, P<0.05). An inverse correlation was found between serum GM-CSF and platelet count (r=-0.4643, P=0.010). There was positive correlation between serum GM-CSF and PAIgG (r=0.4224, P=0.020). CONCLUSIONS Our results suggest that GM-CSF may have a role in the pathogenesis of ITP through activation of the mononuclear phagocyte system, resulting in accelerated destruction and phagocytosis of antibody-coated platelets and decreased platelet count.
Collapse
Affiliation(s)
- Elham A Rizk
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Egypt
| | | | | | | |
Collapse
|
23
|
Soliman AT, elZalabany MM, Ragab M, Abdel Fattah M, Hassab H, Rogol AD, Ansari BM. Spontaneous and GnRH-provoked gonadotropin secretion and testosterone response to human chorionic gonadotropin in adolescent boys with thalassaemia major and delayed puberty. J Trop Pediatr 2000; 46:79-85. [PMID: 10822933 DOI: 10.1093/tropej/46.2.79] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [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: 11/14/2022]
Abstract
To elucidate whether the cause of sexual maturation arrest in thalassaemia is of gonadal or pituitary etiology, 10 males with thalassaemia and delayed puberty and 10 with constitutional delay of growth and pubertal maturation (CSS) were extensively studied. Their spontaneous nocturnal gonadotropin secretion and gonadotropin response to intravenous 100 micrograms gonadotropin-releasing hormone (GnRH) were evaluated. Circulating testosterone concentration and clinical response were evaluated after 3 days, 4 weeks and 6 months of intramuscular administration of human chorionic gonadotropin (HCG) (2500 U/m2/dose). Thalassaemic boys had significantly lower circulating concentrations of testosterone compared to those with constitutional delay of growth and sexual maturation (CSS) at the same pubertal stage. Short- and long-term testosterone response to administrations of HCG was markedly decreased in thalassaemic boys. After 6 months of HCG administration 50 per cent (5/10) of the boys did not show significant testicular enlargement or genital changes. Despite the low circulating concentrations of testosterone, none of the patients had high basal or exaggerated gonadotropin response to gonadotropin releasing hormone (GnRH) stimulation. Luteinizing hormone (LH) peak responses to GnRH were significantly lower as compared to controls. Follicle-stimulating hormone (FSH) peak responses to GnRH did not differ among the two study groups. The mean nocturnal LH and FSH secretion was significantly decreased in all thalassaemic boys as compared to boys with CSS at the same pubertal stage (testicular volume). These data proved that hypogonadotropic hypogonadism is the main cause of delayed/failed puberty in adolescents with thalassaemia major. MRI studies revealed complete empty sella (n = 5), marked diminution of the pituitary size (n = 5), thinning of the pituitary stalk (n = 3) with its posterior displacement (n = 2), and evidence of iron deposition in the pituitary gland and midbrain (n = 8) in thalassaemic patients, denoting a high incidence of structural abnormalities (atrophy) of the pituitary gland. Moreover, in many of the thalassaemic boys, the defective testosterone response to long-term (6 months) HCG therapy denoted significant testicular atrophy and/or failure secondary to siderosis. It appears that testosterone replacement might be superior to HCG therapy in these patients. This therapy should be introduced at the proper time in these hypogonadal patients to induce their sexual development and to support their linear growth spurt and bone mineral accretion.
Collapse
Affiliation(s)
- A T Soliman
- Department of Pediatrics, University of Alexandria, Egypt.
| | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
Between 1986 and 1997, 21 children (ten boys and 11 girls) had surgery for hydatid disease of the liver. Their mean age was 6.5 years (range 3-12). Abdominal distention with a mass was the commonest presenting symptom (71.4%), followed by abdominal pain (38%). Hepatomegaly with a palpable mass was present in 12 (57%). Three children had concomitant pulmonary and brain hydatid disease. The diagnosis was established clinically and by skin testing, serology and imaging techniques. All patients received a pre-operative course of mebendazole (50 mg/kg/day) for between 1 and 8 weeks. At surgery, 11 children had a single cyst, eight of which were in the right lobe of the liver. Ten children had multiple cysts occupying both liver lobes. Three forms of surgical treatment were used: capitonnage + partial excision of fibrous capsule; total excision of the cyst; and external drainage of the cyst cavity. Three children required re-operation. Mean follow-up time was 24 months. There were no deaths, but five children developed post-operative complications. Surgical treatment in the form of primary closure of the cyst cavity without drainage seems to offer the best therapeutic option for patients with large hydatid cysts.
Collapse
Affiliation(s)
- A al-Bassam
- Department of Surgery, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | | | | | | | | | | |
Collapse
|