1
|
Al-Samkari H, Shehata N, Lang-Robertson K, Bianchi P, Glenthøj A, Sheth S, Neufeld EJ, Rees DC, Chonat S, Kuo KHM, Rothman JA, Barcellini W, van Beers EJ, Pospíšilová D, Shah AJ, van Wijk R, Glader B, Mañú Pereira MDM, Andres O, Kalfa TA, Eber SW, Gallagher PG, Kwiatkowski JL, Galacteros F, Lander C, Watson A, Elbard R, Peereboom D, Grace RF. Diagnosis and management of pyruvate kinase deficiency: international expert guidelines. Lancet Haematol 2024; 11:e228-e239. [PMID: 38330977 DOI: 10.1016/s2352-3026(23)00377-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 02/10/2024]
Abstract
Pyruvate kinase (PK) deficiency is the most common cause of chronic congenital non-spherocytic haemolytic anaemia worldwide, with an estimated prevalence of one in 100 000 to one in 300 000 people. PK deficiency results in chronic haemolytic anaemia, with wide ranging and serious consequences affecting health, quality of life, and mortality. The goal of the International Guidelines for the Diagnosis and Management of Pyruvate Kinase Deficiency was to develop evidence-based guidelines for the clinical care of patients with PK deficiency. These clinical guidelines were developed by use of GRADE methodology and the AGREE II framework. Experts were invited after consideration of area of expertise, scholarly contributions in PK deficiency, and country of practice for global representation. The expert panel included 29 expert physicians (including adult and paediatric haematologists and other subspecialists), geneticists, laboratory specialists, nurses, a guidelines methodologist, patients with PK deficiency, and caregivers from ten countries. Five key topic areas were identified, the panel prioritised key questions, and a systematic literature search was done to generate evidence summaries that were used in the development of draft recommendations. The expert panel then met in person to finalise and vote on recommendations according to a structured consensus procedure. Agreement of greater than or equal to 67% among the expert panel was required for inclusion of a recommendation in the final guideline. The expert panel agreed on 31 total recommendations across five key topics: diagnosis and genetics, monitoring and management of chronic complications, standard management of anaemia, targeted and advanced therapies, and special populations. These new guidelines should facilitate best practices and evidence-based PK deficiency care into clinical practice.
Collapse
Affiliation(s)
- Hanny Al-Samkari
- Division of Hematology Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Nadine Shehata
- Departments of Medicine and Laboratory Medicine and Pathobiology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Paola Bianchi
- Hematology Unit, Pathophysiology of Anemias Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andreas Glenthøj
- Danish Red Blood Cell Center, Department of Hematology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Sujit Sheth
- Division of Pediatric Hematology/Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Ellis J Neufeld
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - David C Rees
- Department of Paediatric Haematology, King's College London, King's College Hospital, London, UK
| | - Satheesh Chonat
- Pediatric Hematology/Oncology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Kevin H M Kuo
- Division of Medical Oncology and Hematology, University Health Network, University of Toronto, ON, Canada
| | | | - Wilma Barcellini
- Hematology Unit, Pathophysiology of Anemias Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eduard J van Beers
- Benign Hematology Center, Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Dagmar Pospíšilová
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Ami J Shah
- Division of Stem Cell Transplantation and Regenerative Medicine, Lucile Packard Children Hospital, Stanford School of Medicine, Palo Alto, CA, USA
| | - Richard van Wijk
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Bertil Glader
- Division of Pediatric Hematology/Oncology, Lucile Packard Children Hospital, Stanford School of Medicine, Palo Alto, CA, USA
| | - Maria Del Mar Mañú Pereira
- Rare Anaemia Disorders Research Laboratory, Institut de Recerca - Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Oliver Andres
- Centre of Inherited Blood Cell Disorders, University Hospital Würzburg, Würzburg, Germany
| | - Theodosia A Kalfa
- Division of Hematology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stefan W Eber
- Department of Pediatrics, Practice for Pediatric Hematology and Hemostaseology, University Children's Hospital, Technical University, Munich, Germany
| | - Patrick G Gallagher
- Department of Pediatrics, Center for Perinatal Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Janet L Kwiatkowski
- Division of Hematology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Carl Lander
- Thrive with Pyruvate Kinase Deficiency Foundation, Bloomington, MN, USA
| | | | - Riyad Elbard
- Thalassemia International Federation, Nicosia, Cyprus
| | | | - Rachael F Grace
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Horgan D, Moss B, Boccia S, Genuardi M, Gajewski M, Capurso G, Fenaux P, Gulbis B, Pellegrini M, Mañú Pereira MDM, Gutiérrez Valle V, Gutiérrez Ibarluzea I, Kent A, Cattaneo I, Jagielska B, Belina I, Tumiene B, Ward A, Papaluca M. Time for Change? The Why, What and How of Promoting Innovation to Tackle Rare Diseases - Is It Time to Update the EU's Orphan Regulation? And if so, What Should be Changed? Biomed Hub 2021; 5:1-11. [PMID: 33564657 DOI: 10.1159/000509272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/04/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022] Open
Abstract
Since developments are global in the healthcare arena, more should be done to align EU and other big markets' regulatory practices for rare disease patients. Notwithstanding efforts and cooperation between the US and EU aimed to harmonize their strategic plans in the field of orphan drugs, regulatory criteria and procedures to gain the designation, terms and classifications should be still harmonised. Aligning the criteria of prevalence and support to orphan medicines in the various jurisdictions internationally, would facilitate patient recruitment eventually at global level, so as to gain the data and the biological insights required to identify biomarkers and appropriate endpoints needed for progressing clinical development. A conducive regulatory environment can further support the development of medicines to treat rare diseases. Overall there is a need for joined-up regulatory process coordination. Better integration of regulatory pathways and better integration of regulatory systems, such as scientific tools and methods to generate evidence, would be helpful. There is a need to revise and agree the current frameworks to be improved which will take into account the considerations and challenges to diagnose and treat different rare diseases and improve quality of life. Deliberative processes with multi-stakeholders' involvement for reimbursement should be considered. This paper explores the successes and limitation of both the regulation and its implementation mechanisms in the current regulatory context, and suggests some improvements that could maximise its benefits and boost rare disease research even further.
Collapse
Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, Brussels, Belgium
| | - Barbara Moss
- Europacolon (UK), London, United Kingdom.,Bowel Cancer UK, London, United Kingdom
| | - Stefania Boccia
- Sezione di Igiene, Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maurizio Genuardi
- European Society of Human Genetics, Vienna, Austria.,Complex Operational Unit, Medical Genetics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Gabriele Capurso
- PancreatoBiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Pierre Fenaux
- Service d'hématologie seniors, Hôpital St Louis / Université Paris 7, Paris, France.,ERN-EuroBloodNet, the European Reference Network on Rare Hematological Disease, Paris, France
| | - Beatrice Gulbis
- ERN-EuroBloodNet, the European Reference Network on Rare Hematological Disease, Paris, France.,Ht. ERASME-CUB, Brussels, LHUB-ULB, Brussels, Belgium
| | - Mariangela Pellegrini
- ERN-EuroBloodNet, the European Reference Network on Rare Hematological Disease, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Maria Del Mar Mañú Pereira
- ERN-EuroBloodNet, the European Reference Network on Rare Hematological Disease, Paris, France.,University Hospital Vall d'Hebron - Vall d'Hebron Research Institute, Barcelona, Spain
| | - Victoria Gutiérrez Valle
- ERN-EuroBloodNet, the European Reference Network on Rare Hematological Disease, Paris, France.,University Hospital Vall d'Hebron - Vall d'Hebron Research Institute, Barcelona, Spain
| | - Iñaki Gutiérrez Ibarluzea
- EuroScan International Network, Cologne, Germany.,BIOEF, Basque Foundation for Health Innovation and Research, Barakaldo, Basque Country, Spain
| | - Alastair Kent
- Independent Patient Advocate, London, United Kingdom
| | | | - Beata Jagielska
- Clinic of Oncological Diagnosis and Cardio-oncology, Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland
| | - Ivica Belina
- Coalition of Healthcare Association, Zagreb, Croatia
| | - Birute Tumiene
- Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Adrian Ward
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | |
Collapse
|
3
|
Abstract
Las anemias raras y los fallos medulares hereditarios son enfermedades hematológicas caracterizadas, respectivamente, por una disminución de la concentración de hemoglobina o por diversos grados de defectos en la producción de células hematopoyéticas que conducen desde una citopenia de un solo linaje hasta una de múltiples linajes. Son enfermedades raras y difíciles de diagnosticar debido a la heterogeneidad clínica, citológica y genética. En este artículo abordaremos en primer lugar el diagnóstico de las anemias raras y sus causas principales: fallos medulares, defectos del hematíe y trastornos del metabolismo de los factores de maduración eritrocitario. Seguidamente introduciremos los fallos medulares hereditarios y su patología asociada, como son las malformaciones congénitas y la predisposición tumoral, haciendo especial hincapié en los más frecuentes: la anemia de Fanconi, la disqueratosis congénitca, la anemia de Diamond-Blackfan y el síndrome de Shwachman-Diamond.
Collapse
|
4
|
Aguilar Martinez P, Angastiniotis M, Eleftheriou A, Gulbis B, Mañú Pereira MDM, Petrova-Benedict R, Corrons JLV. Haemoglobinopathies in Europe: health & migration policy perspectives. Orphanet J Rare Dis 2014; 9:97. [PMID: 24980780 PMCID: PMC4094755 DOI: 10.1186/1750-1172-9-97] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/06/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Major haemoglobinopathies (MH), such as thalassaemia syndromes (Thal) and sickle cell disorders (SCD), are genetic defects associated with chronic anaemia and other complications. In Europe, MH are rare diseases (RD) but their prevalence is significantly growing in many countries due to mobility and migration flows. This creates a growing health problem in the EU that has not yet been effectively addressed by Member States (MS) authorities. The present study has been conducted with the aim of: (i) providing an overview of policies for MH in 10 EU member states (MS) (ii) analysing the challenges linked to these RD due to growing requirements imposed by population, mobility and migration trends and (iii) identifying gaps, proposing improvements on existing policies, or developing new ones to fit the identified needs. METHODS The study has been undertaken by a group of members of the European Network for Rare and Congenital Anaemias (ENERCA) and the Thalassaemia International Federation (TIF), in collaboration with the public affairs firm Burson-Marsteller Brussels. Data from 10 EU countries have been gathered using targeted desk research and one-to-one interviews with local stakeholders, including healthcare professionals, patients and public health officers/providers. RESULTS 1. MH are the most common RD in all the 10 countries, 2. Data on prevalence, overall burden, trends, and clinical follow up costs are lacking in most countries. 3. Neonatal screening practices show a wide variation across and within countries. 4. Awareness on MH and their related complications is very low, exception made of Italy, Greece, Cyprus and UK, 5. No disaggregated data is available to understand the impact of mobility and migration on the prevalence of haemoglobinopathies, and how healthcare delivery systems should adapt to respond to this situation. 6. Targeted policy measures and/or actions are generally lacking and/or delayed. CONCLUSIONS Ten policy recommendations have been drawn from this study, building on 2006 WHO recommendations for MH to include haemoglobinopathies in National Plans of Actions for Rare Diseases.
Collapse
Affiliation(s)
| | | | | | - Beatrice Gulbis
- Clinical Chemistry Department, Hôpital Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Del Mar Mañú Pereira
- Red Cell Pathology Unit, Hospital Clinic. University of Barcelona, c/ Villarroel 170, 08036 Barcelona, Spain
| | - Roumyana Petrova-Benedict
- International Organization for Migration (IOM), Migration Health Division (MHD), Regional office (RO), Brussels, Belgium
| | - Joan-Lluis Vives Corrons
- Red Cell Pathology Unit, Hospital Clinic. University of Barcelona, c/ Villarroel 170, 08036 Barcelona, Spain
| |
Collapse
|
5
|
Vives-Corrons JL, Koralkova P, Grau JM, Mañú Pereira MDM, Van Wijk R. First description of phosphofructokinase deficiency in spain: identification of a novel homozygous missense mutation in the PFKM gene. Front Physiol 2013; 4:393. [PMID: 24427140 PMCID: PMC3875906 DOI: 10.3389/fphys.2013.00393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 11/02/2013] [Accepted: 12/13/2013] [Indexed: 12/04/2022] Open
Abstract
Phosphofructokinase deficiency is a very rare autosomal recessive disorder, which belongs to group of rare inborn errors of metabolism called glycogen storage disease. Here we report on a new mutation in the phosphofructokinase (PFK) gene PFKM identified in a 65-years-old woman who suffered from lifelong intermittent muscle weakness and painful spasms of random occurrence, episodic dark urines, and slight haemolytic anemia. After ruling out the most common causes of chronic haemolytic anemia, the study of a panel of 24 enzyme activities showed a markedly decreased PFK activity in red blood cells (RBCs) from the patient. DNA sequence analysis of the PFKM gene subsequently revealed a novel homozygous mutation: c.926A>G; p.Asp309Gly. This mutation is predicted to severely affect enzyme catalysis thereby accounting for the observed enzyme deficiency. This case represents a prime example of classical PFK deficiency and is the first reported case of this very rare red blood cell disorder in Spain.
Collapse
Affiliation(s)
- Joan-Lluis Vives-Corrons
- Red Cell Pathology Unit, Biomedical Dianostic Centre, University Hospital Clínic de Barcelona Barcelona, Spain
| | - Pavla Koralkova
- Faculty of Medicine and Dentistry, Department of Biology, Palacky University Olomouc, Czech Republic
| | - Josep M Grau
- Service of Internal Medicine and Muscle, University Hospital Clínic de Barcelona Barcelona, Spain
| | - Maria Del Mar Mañú Pereira
- Red Cell Pathology Unit, Biomedical Dianostic Centre, University Hospital Clínic de Barcelona Barcelona, Spain
| | - Richard Van Wijk
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht Utrecht, Netherlands
| |
Collapse
|