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McGuire C, Young NL, Livingston J, Dhir V, Blanchette VS, Kirby-Allen M, Klaassen RJ. Face validity of the Kids' ITP Tools (KIT) in the era of thrombopoietin receptor agonists. Pediatr Blood Cancer 2024; 71:e30888. [PMID: 38265264 DOI: 10.1002/pbc.30888] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/25/2024]
Abstract
The Kids' ITP Tools (KIT) is a questionnaire to assess quality of life of children with immune thrombocytopenia (ITP). The aim of this study was to update this previously validated tool to align with changes in clinical practice, specifically, treatment with thrombopoietin receptor agonists (TPO-RAs). Children aged 1-18 with ITP and/or their families were recruited to participate in interviews to review the KIT. Twenty-six interviews were conducted. Based on interview data from children and families, current guidelines, and expert opinion, five changes were made to the KIT in order to improve its face validity.
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Affiliation(s)
- Catherine McGuire
- The Children's Hospital of Eastern Ontario (CHEO), The University of Ottawa, Ottawa, Ontario, Canada
| | - Nancy L Young
- The Children's Hospital of Eastern Ontario (CHEO), The University of Ottawa, Ottawa, Ontario, Canada
| | - Joel Livingston
- Department of Pediatrics, The Stollery Children's Hospital, The University of Alberta, Edmonton, Alberta, Canada
| | - Vinita Dhir
- The Children's Hospital of Eastern Ontario (CHEO), The University of Ottawa, Ottawa, Ontario, Canada
| | - Victor S Blanchette
- The Children's Hospital of Eastern Ontario (CHEO), The University of Ottawa, Ottawa, Ontario, Canada
| | - Melanie Kirby-Allen
- The Hospital for Sick Children (SickKids), The University of Toronto, Toronto, Ontario, Canada
| | - Robert J Klaassen
- The Children's Hospital of Eastern Ontario (CHEO), The University of Ottawa, Ottawa, Ontario, Canada
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2
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Klonizakis P, Roy N, Papatsouma I, Mainou M, Christodoulou I, Pantelidou D, Kokkota S, Diamantidis M, Kourakli A, Lazaris V, Andriopoulos D, Tsapas A, Klaassen RJ, Vlachaki E. A Cross-Sectional, Multicentric, Disease-Specific, Health-Related Quality of Life Study in Greek Transfusion Dependent Thalassemia Patients. Healthcare (Basel) 2024; 12:524. [PMID: 38470634 PMCID: PMC10931193 DOI: 10.3390/healthcare12050524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
The assessment of health-related quality of life (HRQoL) in thalassemia offers a holistic approach to the disease and facilitates better communication between physicians and patients. This study aimed to evaluate the HRQoL of transfusion-dependent thalassemia (TDT) patients in Greece. This was a multicentric, cross-sectional study conducted in 2017 involving 283 adult TDT patients. All participants completed a set of two QoL questionnaires, the generic SF-36v2 and the disease-specific TranQol. Demographic and clinical characteristics were used to predefine patient subgroups. Significant factors identified in the univariate analysis were entered into a multivariate analysis to assess their effect on HRQoL. The SF-36 scores of TDT patients were consistently lower compared to the general population in Greece. The mean summary score of TranQol was relatively high (71 ± 14%), exceeding levels observed in national surveys in other countries. Employment emerged as the most significant independent factor associated with better HRQoL, whereas age had the most significant negative effect. This study represents the first comprehensive QoL assessment of a representative sample of the TDT population in Greece. The implementation of TranQol allowed for the quantification of HRQoL in Greece, establishing a baseline for future follow-up, and identifying more vulnerable patient subgroups.
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Affiliation(s)
- Philippos Klonizakis
- Adults Thalassemia Unit-2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (M.M.); (I.C.); (E.V.)
| | - Noémi Roy
- Department of Haematology, Oxford University Hospitals, NHS Foundation Trust, Oxford OX3 0AG, UK;
| | - Ioanna Papatsouma
- Department of Mathematics, Imperial College London, London SW7 2BP, UK;
| | - Maria Mainou
- Adults Thalassemia Unit-2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (M.M.); (I.C.); (E.V.)
| | - Ioanna Christodoulou
- Adults Thalassemia Unit-2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (M.M.); (I.C.); (E.V.)
| | - Despina Pantelidou
- Thalassemia Unit, AHEPA General Hospital of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.K.)
| | - Smaro Kokkota
- Thalassemia Unit, AHEPA General Hospital of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.K.)
| | - Michael Diamantidis
- Thalassemia and Sickle Cell Disease Unit, General Hospital of Larissa, 41110 Larissa, Greece;
| | - Alexandra Kourakli
- Thalassemia and Hemoglobinopathies Center, University Hospital of Patras, 26504 Patras, Greece; (A.K.); (V.L.)
| | - Vasileios Lazaris
- Thalassemia and Hemoglobinopathies Center, University Hospital of Patras, 26504 Patras, Greece; (A.K.); (V.L.)
| | - Dimitrios Andriopoulos
- Haemato-Oncology Department, Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK;
| | - Apostolos Tsapas
- 2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
| | - Robert J. Klaassen
- Department of Pediatrics, Division of Hematology/Oncology, University of Ottawa, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada;
| | - Efthymia Vlachaki
- Adults Thalassemia Unit-2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (M.M.); (I.C.); (E.V.)
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Longmuir PE, Chubbs Payne A, Beshara N, Brandão LR, Wright FV, Pohl D, Katz SL, McCormick A, De Laat D, Klaassen RJ, Johnston DL, Lougheed J, Roth J, McMillan HJ, Venkateswaran S, Sell E, Doja A, Boafo A, Macartney G, Matheson K, Feldman BM. Quick, Effective Screening Tasks Identify Children With Medical Conditions or Disabilities Needing Physical Literacy Support. Pediatr Exerc Sci 2024:1-11. [PMID: 38171358 DOI: 10.1123/pes.2023-0130] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE This study evaluated screening tasks able to identify children with medical conditions or disabilities who may benefit from physical literacy. METHOD Children completed ≤20 screening tasks during their clinic visit and then the Canadian Assessment of Physical Literacy (2nd edition) at a separate visit. Total Canadian Assessment of Physical Literacy scores <30th percentile were categorized as potentially needing physical literacy support. Receiver operator characteristic curves identified assessment cut points with 80% sensitivity and 40% specificity relative to total physical literacy scores. RESULTS 223 children (97 girls; 10.1 [2.6] y) participated. Physical activity adequacy, predilection, and physical competence achieved ≥80% sensitivity and ≥40% specificity in both data sets. Adequacy ≤ 6.5 had 86% to 100% sensitivity and 48% to 49% specificity. Daily screen time >4.9 hours combined with Adequacy ≤6.15 had 88% to 10% sensitivity and 53% to 56% specificity. CONCLUSIONS Activity adequacy, alone or with screen time, most effectively identified children likely to benefit from physical literacy support. Adequacy and screen time questionnaires are suitable for clinical use. Similar results regardless of diagnosis suggest physical competence deficits are not primary determinants of active lifestyles. Research to enhance screening specificity is required.
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Affiliation(s)
- Patricia E Longmuir
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON,Canada
| | - Adam Chubbs Payne
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
| | - Natalie Beshara
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
| | - Leonardo R Brandão
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON,Canada
- Faculty of Medicine, University of Toronto, Toronto, ON,Canada
| | - F Virginia Wright
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON,Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON,Canada
| | - Daniela Pohl
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Sherri Lynne Katz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Respirology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Anna McCormick
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON,Canada
- Division of Developmental Pediatrics and Rehabilitation Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Denise De Laat
- Division of Developmental Pediatrics and Rehabilitation Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Robert J Klaassen
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Donna L Johnston
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Jane Lougheed
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Johannes Roth
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Hugh J McMillan
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Sunita Venkateswaran
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Erick Sell
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Asif Doja
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Addo Boafo
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Gail Macartney
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON,Canada
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, PE,Canada
| | - Katherine Matheson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Brian M Feldman
- Faculty of Medicine, University of Toronto, Toronto, ON,Canada
- Division of Rheumatology, Department of Pediatrics, and the Institute of Health Policy and Evaluation, The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, ON,Canada
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Andrae DA, Grace RF, Jewett A, Foster B, Klaassen RJ, Salek S, Li J, Tai F, Boscoe AN, Zagadailov E. Psychometric validation of the Pyruvate Kinase Deficiency Diary and Pyruvate Kinase Deficiency Impact Assessment in adults in the phase 3 ACTIVATE trial. J Patient Rep Outcomes 2023; 7:112. [PMID: 37943362 PMCID: PMC10636000 DOI: 10.1186/s41687-023-00650-3] [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: 03/30/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Pyruvate kinase (PK) deficiency is a rare hereditary disorder characterized by chronic hemolytic anemia and serious sequalae which negatively affect patient quality of life. This study aimed to psychometrically validate the first disease-specific patient-reported outcome (PRO) instruments: the 7-item PK Deficiency Diary (PKDD) and 12-item PK Deficiency Impact Assessment (PKDIA), designed to assess signs, symptoms, and impacts of PK deficiency in patients enrolled in the ACTIVATE global phase 3 study of mitapivat versus placebo (NCT03548220). METHODS All validation analyses for the PKDD and PKDIA were performed on blinded data, with analyses on item integrity, scoring, reliability, and validity conducted on data from screening and baseline. Completion rates and baseline response distributions were characterized using descriptive statistics. Item response modelling was used to inform a weighted scoring system. Reliability was assessed by internal consistency and test-retest reliability; and validity by convergent and known-groups analyses. RESULTS Of the 80 adults enrolled, baseline data were available for 77 (96.3%) and 78 (97.5%) patients for the PKDD and PKDIA, respectively. Item responses skewed right, indicating that mean values exceeded median values, especially for items utilizing a 0-10 numeric scale, which were subsequently recoded to a 0-4 scale; 4 items were removed from the PKDIA due to redundancy or low relevance to the trial population. Both the PKDD and PKDIA demonstrated high internal consistency (McDonald's coefficient ω = 0.86 and 0.90, respectively), test-retest reliability (intra-class coefficients of 0.94 and 0.87, respectively), and convergent validity with other PROs (linear correlation coefficients [|r|] between 0.30-0.73 and 0.50-0.82, respectively). CONCLUSIONS The findings provide evidence of validity and reliability for the PKDD and PKDIA, the first disease-specific PRO measures for PK deficiency, and can therefore increase understanding of, and more accurately capture, the wider impact of PK deficiency on health-related quality of life. Trial registration ClinicalTrials.gov, NCT03548220. Registered June 07, 2018; https://www. CLINICALTRIALS gov/ct2/show/NCT03548220 .
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Affiliation(s)
| | - Rachael F Grace
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Robert J Klaassen
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Junlong Li
- Agios Pharmaceuticals, Inc., 88 Sidney Street, Cambridge, MA, 02139-4169, USA
| | - Feng Tai
- Agios Pharmaceuticals, Inc., 88 Sidney Street, Cambridge, MA, 02139-4169, USA
| | - Audra N Boscoe
- Agios Pharmaceuticals, Inc., 88 Sidney Street, Cambridge, MA, 02139-4169, USA.
| | - Erin Zagadailov
- Agios Pharmaceuticals, Inc., 88 Sidney Street, Cambridge, MA, 02139-4169, USA
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Ibrahim L, Dong SX, O'Hearn K, Grimes AB, Kaicker S, FritchLilla S, Breakey VR, Grace RF, Lebensburger JD, Klaassen RJ, Lambert M. Pediatric refractory immune thrombocytopenia: A systematic review. Pediatr Blood Cancer 2023; 70:e30173. [PMID: 36579787 DOI: 10.1002/pbc.30173] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/30/2022]
Abstract
Pediatric immune thrombocytopenia (ITP) is an acquired disorder associated with autoimmune destruction and impairment of platelet production in children. Some children exhibit poor or transient response to ITP-directed treatments and are referred to as having refractory ITP (rITP). There is currently no consensus on the definition of rITP, nor evidence-based treatment guidelines for patients with rITP. After a survey of pediatric ITP experts demonstrated lack of consensus on pediatric rITP, we pursued a systematic review to examine the reported clinical phenotypes and treatment outcomes in pediatric rITP. The search identified 253 relevant manuscripts; following review, 11 studies proposed a definition for pediatric rITP with no consensus amongst them. Most definitions included suboptimal response to medical management, while some outlined specific platelet thresholds to define this suboptimal response. Common attributes identified in this study should be used to propose a comprehensive definition, which will facilitate outcome comparisons of future rITP studies.
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Affiliation(s)
- Layan Ibrahim
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Selina X Dong
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Katie O'Hearn
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Amanda B Grimes
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hematology Center, Houston, Texas, USA
| | - Shipra Kaicker
- Division of Pediatric Hematology and Oncology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA
| | - Stephanie FritchLilla
- Cancer and Blood Disorders Program, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Vicky R Breakey
- Division of Pediatric Hematology/Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Rachael F Grace
- Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Robert J Klaassen
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Michele Lambert
- Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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6
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Livingston J, Alrajhi Z, Jackson M, McGuire C, Newhook D, Klaassen RJ, Kirby-Allen M. Evaluating the impact of thrombopoietin receptor agonist medications on patient outcomes and quality of life in paediatric immune thrombocytopenia through semi-structured interviews. Br J Haematol 2023; 200:506-516. [PMID: 36345812 DOI: 10.1111/bjh.18545] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022]
Abstract
Over the last decade, treatment of immune thrombocytopenia (ITP) in children has advanced to include thrombopoietin receptor agonist (TPO-RA) medications. Concurrently, there has been an increased emphasis on patient-reported outcomes-especially quality of life-to guide treatment. Assessing the impact of TPO-RAs on quality of life in paediatric ITP is therefore a priority. In this single-centre integrative mixed-methods study, a cohort of children with ITP prescribed a TPO-RA was identified. These children and/or their caregivers were invited to participate in semi-structured interviews focussed on quality-of-life measures. Independently, a retrospective chart review collected ITP-related data (platelet count, bleeding events) and TPO-RA data (dosing, side effects). Among the 23 eligible patients, 20 were represented in interviews. On chart review, 11/20 patients responded to TPO-RA by meeting platelet count criteria of ≥50 × 109 /L for six or more weeks in the absence of rescue therapy. In interviews with these children and/or their parents, 19/20 expressed the TPO-RA had 'worked', with 11/20 reporting benefit to mood and 11/20 reporting increased participation in activities/sports. Concerns were raised in interviews about TPO-RA medication cost (17/20), medication administration (10/20) and potential side effects (10/20). In conclusion, this study suggests that TPO-RA use in children with ITP improves quality of life.
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Affiliation(s)
- Joel Livingston
- The Hospital for Sick Children (SickKids), The University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, The University of Alberta, Alberta, Edmonton, Canada
| | - Ziyad Alrajhi
- The Hospital for Sick Children (SickKids), The University of Toronto, Toronto, Ontario, Canada.,King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Melanie Jackson
- The Hospital for Sick Children (SickKids), The University of Toronto, Toronto, Ontario, Canada
| | - Catherine McGuire
- The Children's Hospital of Eastern Ontario (CHEO), The University of Ottawa, Ottawa, Ontario, Canada
| | - Dennis Newhook
- The Children's Hospital of Eastern Ontario (CHEO), The University of Ottawa, Ottawa, Ontario, Canada
| | - Robert J Klaassen
- The Children's Hospital of Eastern Ontario (CHEO), The University of Ottawa, Ottawa, Ontario, Canada
| | - Melanie Kirby-Allen
- The Hospital for Sick Children (SickKids), The University of Toronto, Toronto, Ontario, Canada
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7
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Hillier K, Rothman JA, Klaassen RJ, Neunert C, Rose MJ, Grace RF, Lambert MP. SARS-CoV-2 vaccination in pediatric patients with immune thrombocytopenia. Pediatr Blood Cancer 2022; 69:e29760. [PMID: 35561101 PMCID: PMC9347939 DOI: 10.1002/pbc.29760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Kirsty Hillier
- Department of PediatricsDivision of Pediatric Hematology‐OncologyHassenfeld Children's Hospital at NYU Langone HealthNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Jennifer A. Rothman
- Department of PediatricsDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Robert J. Klaassen
- Division of Hematology/Oncology, Department of PediatricsChildren's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada
| | - Cindy Neunert
- Division of Hematology/Oncology/Stem Cell Transplant, Department of PediatricsColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Melissa J. Rose
- Nationwide Children's and The Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Rachael F. Grace
- Pediatric Hematology/OncologyDana‐Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical SchoolBostonMassachusettsUSA
| | - Michele P. Lambert
- Division of HematologyThe Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA,Department of PediatricsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Kwon JY, Russell L, Coles T, Klaassen RJ, Schick-Makaroff K, Sibley KM, Mitchell SA, Sawatzky R. Patient-Reported Outcomes Measurement in Radiation Oncology: Interpretation of Individual Scores and Change over Time in Clinical Practice. Curr Oncol 2022; 29:3093-3103. [PMID: 35621641 PMCID: PMC9139498 DOI: 10.3390/curroncol29050251] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 12/03/2022] Open
Abstract
Tools for measuring patients’ perceived health and quality of life, such as patient-reported outcome measures (PROMs), inform clinical decisions for patients requiring radiation therapy. However, there may be inconsistencies in how patients interpret and respond to PROMs due to cultural, environmental, personal, or experiential factors. Differential item functioning (DIF) and response shift (RS) refer to differences in the meaning of PROMs between patients or over time (respectively). DIF and RS can threaten the accurate interpretation and use of PROMs, potentially resulting in erroneous conclusions about effectiveness, and flawed individual-level clinical decision-making. Given the empirical evidence of DIF and RS, we aim to review clinical implications and solutions for addressing DIF and RS by providing vignettes from collaborative examinations with workshop participants, as well as the literature. By making these methodological concepts accessible and relevant, for practice, clinicians may feel more confident to ask clarifying questions of patients when PROM scores and the contextual patient information do not align. PROM scores need to be interpreted via dialogue with the patient to avoid misinterpretation due to DIF and RS, which could diminish patient–clinician communication and impede shared decision-making. This work is part of an interdisciplinary knowledge translation initiative focused on the interpretation of PROM scores by clinically-oriented audiences.
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Affiliation(s)
- Jae-Yung Kwon
- School of Nursing, University of Victoria, Victoria, BC V8P 5C2, Canada
- Institute on Aging and Lifelong Health, Victoria, BC V8N 5C2, Canada
- Correspondence:
| | - Lara Russell
- School of Nursing, Trinity Western University, Langley, BC V2Y 1Y1, Canada; (L.R.); (R.S.)
| | - Theresa Coles
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, USA;
| | - Robert J. Klaassen
- Division of Hematology/Oncology, Department of Pediatrics, Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | | | - Kathryn M. Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada;
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
| | - Sandra A. Mitchell
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20850, USA;
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, BC V2Y 1Y1, Canada; (L.R.); (R.S.)
- Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC V6Z 2K5, Canada
- Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
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9
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Lim YJ, Arbiv OA, Kalbfleisch ME, Klaassen RJ, Fernandez C, Rayar M, Steele M, Lipton JH, Cuvelier G, Pastore YD, Silva M, Brossard J, Michon B, Abish S, Sinha R, Corriveau-Bourque C, Breakey VR, Tole S, Goodyear L, Sung L, Zlateska B, Cada M, Dror Y. Poor Outcome After Hematopoietic Stem Cell Transplantation Of Patients With Unclassified Inherited Bone Marrow Failure Syndromes. Eur J Haematol 2021; 108:278-287. [PMID: 34897809 DOI: 10.1111/ejh.13733] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022]
Abstract
Classification of inherited bone marrow failure syndromes (IBMFSs) according to clinical and genetic diagnoses enables proper adjustment of treatment. Unfortunately, 30% of patients enrolled in the Canadian Inherited Marrow Failure Registry (CIMFR) with features suggesting hereditability could not be classified with a specific syndromic diagnosis. We analyzed the outcome of hematopoietic stem cell transplantation (HSCT) in unclassified IBMFSs (uIBMFSs) and the factors associated with outcome. Twenty-two patients with uIBMFSs and 70 patients with classified IBMFSs underwent HSCT. Five-year overall survival of uIBMFS patients after HSCT was inferior to that of patients with classified IBMFSs (56% vs 76.5%). The outcome of patients with uIBMFS who received cord blood was significantly lower than that of patients who received other stem cell sources (14.8% vs 90.9%). Engraftment failure was higher among patients with uIBMFS who received cord blood than those who received bone marrow. None of the following factors was significantly associated with poor survival: transfusion load, transplant indication, the intensity of conditioning regimen, human leukocyte antigen-identical sibling/alternative donor. We suggest that identifying the genetic diagnosis is essential to modulate the transplant procedure including conditioning agents and stem cell sources for better outcome and the standard CBT should be avoided in uIBMFS.
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Affiliation(s)
- Yeon Jung Lim
- The Marrow Failure and Myelodysplasia Program, Division of Haematology/Oncology, Department of Paediatrics, University of Toronto.,Genetics and Genome Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Current Affiliation, Department of Pediatrics, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Omri A Arbiv
- The Marrow Failure and Myelodysplasia Program, Division of Haematology/Oncology, Department of Paediatrics, University of Toronto.,Genetics and Genome Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melanie E Kalbfleisch
- The Marrow Failure and Myelodysplasia Program, Division of Haematology/Oncology, Department of Paediatrics, University of Toronto.,Genetics and Genome Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Meera Rayar
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Josee Brossard
- Centre U Sante de l'Estrie-Fleur, Sherbrooke, Québec, Canada
| | - Bruno Michon
- Centre Hospital University Quebec-Pav CHUL, Sainte-Foy, Québec, Canada
| | - Sharon Abish
- Montreal Children's Hospital, Montreal, Québec, Canada
| | - Roona Sinha
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Vicky R Breakey
- McMaster Children's Hospital/McMaster University Health Sciences Centre, Hamilton, Ontario, Canada
| | - Soumitra Tole
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Lisa Goodyear
- Janeway Child Health Centre, St. John's, Newfoundland, Canada
| | - Lillian Sung
- Child Health and Evaluative Sciences, .The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bozana Zlateska
- The Marrow Failure and Myelodysplasia Program, Division of Haematology/Oncology, Department of Paediatrics, University of Toronto.,Genetics and Genome Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michaela Cada
- The Marrow Failure and Myelodysplasia Program, Division of Haematology/Oncology, Department of Paediatrics, University of Toronto
| | - Yigal Dror
- The Marrow Failure and Myelodysplasia Program, Division of Haematology/Oncology, Department of Paediatrics, University of Toronto.,Genetics and Genome Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Canada
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10
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Chamberlain G, Coltin H, Klaassen RJ, Story E, Abbott LS. Successful treatment of pediatric primary hepatic Burkitt lymphoma using rituximab: A case report. Pediatr Blood Cancer 2021; 68:e29259. [PMID: 34357676 DOI: 10.1002/pbc.29259] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/14/2021] [Indexed: 11/09/2022]
Affiliation(s)
| | - Hallie Coltin
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robert J Klaassen
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Eden Story
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lesleigh S Abbott
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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11
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Amid A, Perkins H, Gauthier J, Bonnefoy A, Carcao M, Rivard GÉ, Klaassen RJ. Immune tolerance induction using Fc-fusion-protein recombinant factor IX in severe haemophilia B. Haemophilia 2021; 27:e776-e779. [PMID: 34599780 DOI: 10.1111/hae.14424] [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] [Received: 01/18/2021] [Revised: 09/08/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ali Amid
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Heather Perkins
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Julie Gauthier
- Molecular Diagnostic Laboratory, CHU Sainte-Justine, Montreal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Arnaud Bonnefoy
- Department of Pediatrics, Université de Montréal, Montreal, Québec, Canada.,Division of Hematology/Oncology, Montreal, Québec, Canada
| | - Manuel Carcao
- Division of Haematology/Oncology, Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Ontario, Canada
| | - Georges-Étienne Rivard
- Department of Pediatrics, Université de Montréal, Montreal, Québec, Canada.,Division of Hematology/Oncology, Montreal, Québec, Canada
| | - Robert J Klaassen
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
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12
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Sun H(L, Yang M, Poon M, Lee A, Robinson KS, Sholzberg M, Wu J, Iorio A, Blanchette V, Carcao M, Klaassen RJ, Jackson S. The impact of extended half-life factor concentrates on patient reported health outcome measures in persons with hemophilia A and hemophilia B. Res Pract Thromb Haemost 2021; 5:e12601. [PMID: 34667922 PMCID: PMC8505988 DOI: 10.1002/rth2.12601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/25/2021] [Accepted: 09/05/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Recombinant factors VIII and IX Fc (rFVIIIFc/rFIXFc) were the only available extended half-life (EHL) products in Canada during 2016 to 2018. OBJECTIVES To evaluate if patient-reported outcome measures (PROMs) improved in Canadian persons with hemophilia who switched from standard half-life (SHL) to EHL products (rFVIIIFc/rFIXFc). PATIENTS/METHODS This prospective cohort study enrolled persons with moderate or severe hemophilia aged ≥6 years who switched to rFVIIIFc/rFIXFc (2016-2018) and those who remained on SHL. Health-related quality of life (HRQoL) was assessed using the Haemophilia-specific Quality of Life (Haem-A-QoL) and 36-item Short-Form Survey (SF-36) at baseline, 3-months, 12 months, and 24 months. Other PROMs included the Work Productivity and Impairment Questionnaire, chronic pain scale, partner/parent ratings of mood, International Physical Activity Questionnaire, and Treatment Satisfaction Questionnaire for Medication. We identified meaningful changes using minimally important difference for SF-36 and responder definition for Haem-A-QoL. RESULTS We enrolled 25 switchers (16 rFVIIIFc, 9 rFIXFc) and 33 nonswitchers. Those switched to rFVIIIFc/rFIXFc had improved overall HRQoL, and improved subscale physical activity, mental health, and social functioning at 3 months. The rFIXFc switchers had improved chronic pain and ability to engage in normal activities while the rFVIIIFc switchers had improved treatment satisfaction. There was no change in work impairment after the switch. Observed improvement disappeared by 24 months in most domains. CONCLUSION Switching from SHL to rFVIIIFc/rFIXFc resulted in short-term meaningful improvement in overall HRQoL and other PROMs in a small proportion. Longitudinal changes on PROMs are affected by ceiling effects and response shift, warranting further studies in instrument optimization in the era of EHL and nonfactor products.
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Affiliation(s)
- Haowei (Linda) Sun
- Division of HematologyDepartment of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Ming Yang
- British Columbia Hemophilia Treatment Centre ‐ Adult DivisionVancouverBritish ColumbiaCanada
| | - Man‐Chiu Poon
- Department of MedicineFoothills Medical CentreCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Adrienne Lee
- Department of MedicineFoothills Medical CentreCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - K. Sue Robinson
- Division of HematologyDepartment of MedicineUniversity of DalhousieHalifaxNova ScotiaCanada
| | - Michelle Sholzberg
- Division of HematologyDepartments of Medicine and Laboratory Medicine & PathobiologySt. Michael's HospitalTorontoOntarioCanada
| | - John Wu
- Division of Hematology OncologyBritish Columbia Children and Women's HospitalVancouverBritish ColumbiaCanada
| | - Alfonso Iorio
- Division of HematologyDepartment of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Victor Blanchette
- Division of Hematology/OncologyDepartment of PediatricsThe Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Manuel Carcao
- Division of Hematology/OncologyDepartment of PediatricsThe Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Robert J. Klaassen
- Division of Hematology OncologyDepartment of PediatricsChildren's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada
| | - Shannon Jackson
- British Columbia Hemophilia Treatment Centre ‐ Adult DivisionVancouverBritish ColumbiaCanada
- Division of HematologyDepartment of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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13
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Stimec J, Dover S, Pullenayegum E, Blanchette VS, Doria AS, Feldman BM, Carcao M, Rivard GE, Israels SJ, Chan AK, Steele M, Cloutier S, Klaassen RJ, Price VE, Sinha R, Laferriere N, Paradis E, Wu JKM, Babyn P. Magnetic resonance imaging in boys with severe hemophilia A: Serial and end-of-study findings from the Canadian Hemophilia Primary Prophylaxis Study. Res Pract Thromb Haemost 2021; 5:e12565. [PMID: 34703973 PMCID: PMC8520573 DOI: 10.1002/rth2.12565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/12/2021] [Accepted: 05/31/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study examined the structural outcomes for joints of boys with severe hemophilia A receiving frequency/dose-escalated primary prophylaxis using magnetic resonance imaging (MRI), and the importance of interval MRI changes. METHODS Forty-six subjects (27 with interval studies) were evaluated by radiographs (X-rays) and mid- and end-of-study MRIs (using the International Prophylaxis Study Group scale), as part of the Canadian Hemophilia Prophylaxis Study. The primary outcome was the presence of MRI osteochondral findings. RESULTS The median (range) time on study at the end-of-study MRI examination was 9.6 (4.8-16.0) years, during which 18 of 46 subjects (39%) had osteochondral changes in at least one joint. An interval change in MRI score of at least 1 point was observed in 44% of joints (43 ankles, 21 elbows, 4 knees); at least one joint showed this change in all 27 subjects. Self-reported interval hemarthrosis was associated with a higher likelihood of interval osteochondral change (odds ratio [OR], 1.49; 95% confidence interval [CI] = 1.08-2.06). Presence of synovial hypertrophy or hemosiderin on interval MRIs was associated with an OR of 4.71 (95% CI, 1.92-11.57) and 5.25 (95% CI, 2.05-13.40) of later osteochondral changes on MRI. DISCUSSION MRI changes were seen in 39% of subjects. Interval index joint bleeding was associated with an increased risk of later MRI changes, and earlier soft-tissue changes were associated with subsequent osteochondral changes.
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Affiliation(s)
- Jennifer Stimec
- Department of Medical ImagingThe Hospital for Sick ChildrenUniversity of TorontoTorontoONCanada
| | - Saunya Dover
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
| | - Eleanor Pullenayegum
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Institute of Health Policy, Management & EvaluationThe Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
| | - Victor S. Blanchette
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
| | - Andrea S. Doria
- Department of Medical ImagingThe Hospital for Sick ChildrenUniversity of TorontoTorontoONCanada
| | - Brian M. Feldman
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Institute of Health Policy, Management & EvaluationThe Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
- Division of RheumatologyThe Hospital for Sick ChildrenTorontoONCanada
| | - Manuel Carcao
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
| | - Georges E. Rivard
- Division of Hematology/OncologyDepartment of PediatricsCHU Sainte‐JustineMontrealQCCanada
| | - Sara J. Israels
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegMBCanada
| | - Anthony K. Chan
- Department of PediatricsMcMaster Children's HospitalMcMaster UniversityHamiltonONCanada
| | - MacGregor Steele
- Section of Pediatric HematologyDepartment of PediatricsUniversity of Calgary and Alberta Children's HospitalCalgaryABCanada
| | - Stephanie Cloutier
- Centre de l’hémophilie de l'est du QuébecHôpital de l'Enfant‐JésusUniversité LavalQuébecQCCanada
| | - Robert J. Klaassen
- Division of Hematology OncologyChildren’s Hospital of Eastern Ontario Research InstituteOttawaONCanada
| | - Victoria E. Price
- Division of Pediatric Hematology/OncologyIWK Health CentreHalifaxNSCanada
| | - Roona Sinha
- Saskatchewan Bleeding Disorders ProgramRoyal University HospitalSaskatoonSKCanada
| | - Nicole Laferriere
- Division of Hematology/OncologyThunder Bay Regional Cancer CareThunder BayONCanada
| | | | - John K. M. Wu
- Division of Hematology/Oncology/BMTDepartment of PediatricsUBC & BC Children’s HospitalVancouverBCCanada
| | - Paul Babyn
- Department of Medical ImagingUniversity of SaskatchewanSaskatoonSKCanada
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14
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Shimano KA, Grace RF, Despotovic JM, Neufeld EJ, Klaassen RJ, Bennett CM, Ma C, London WB, Neunert C. Phase 3 randomised trial of eltrombopag versus standard first-line pharmacological management for newly diagnosed immune thrombocytopaenia (ITP) in children: study protocol. BMJ Open 2021; 11:e044885. [PMID: 34452956 PMCID: PMC8404450 DOI: 10.1136/bmjopen-2020-044885] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Immune thrombocytopaenia (ITP) is an acquired disorder of low platelets and risk of bleeding. Although many children can be observed until spontaneous remission, others require treatment due to bleeding or impact on health-related quality of life. Standard first-line therapies for those who need intervention include corticosteroids, intravenous immunoglobulin and anti-D globulin, though response to these agents may be only transient. Eltrombopag is an oral thrombopoietin receptor agonist approved for children with chronic ITP who have had an insufficient response to corticosteroids, intravenous immunoglobulin or splenectomy. This protocol paper describes an ongoing open-label, randomised trial comparing eltrombopag to standard first-line management in children with newly diagnosed ITP. METHODS AND ANALYSIS Randomised treatment assignment is 2:1 for eltrombopag versus standard first-line management and is stratified by age and by prior treatment. The primary endpoint of the study is platelet response, defined as ≥3 of 4 weeks with platelets >50×109/L during weeks 6-12 of therapy. Secondary outcomes include number of rescue therapies needed during the first 12 weeks, proportion of patients who do not need ongoing treatment at 12 weeks and 6 months, proportion of patients with a treatment response at 1 year, and number of second-line therapies used in weeks 13-52, as well as changes in regulatory T cells, iron studies, bleeding, health-related quality of life and fatigue. A planned sample size of up to 162 randomised paediatric patients will be enrolled over 2 years at 20 sites. ETHICS AND DISSEMINATION The study has been approved by the centralised Baylor University Institutional Review Board. The results are expected to be published in 2023. TRIAL REGISTRATION NUMBER NCT03939637.
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Affiliation(s)
- Kristin A Shimano
- UCSF Benioff Children's Hospital, San Francisco, California, USA
- Pediatrics, UCSF, San Francisco, California, USA
| | - Rachael F Grace
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Jenny M Despotovic
- Texas Children's Hospital, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Ellis J Neufeld
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Carolyn M Bennett
- Pediatrics, Emory University, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Clement Ma
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Wendy B London
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- Biostatistics, Harvard Medical School, Boston, Massachusetts, USA
| | - Cindy Neunert
- Pediatrics, Columbia University Medical School, New York, New York, USA
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15
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Perkins H, Klaassen RJ. Successful use of recombinant activated factor VII administered via automated bolus pump following emergency laparoscopic appendectomy in a patient with mild congenital FVII deficiency: Case report. Pediatr Blood Cancer 2021; 68:e28974. [PMID: 33629793 DOI: 10.1002/pbc.28974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/19/2021] [Accepted: 02/03/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Heather Perkins
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert J Klaassen
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
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16
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Khangura SD, Potter BK, Davies C, Ducharme R, Bota AB, Hawken S, Wilson K, Karaceper MD, Klaassen RJ, Little J, Simpson E, Chakraborty P. Health services use by children identified as heterozygous hemoglobinopathy mutation carriers via newborn screening. BMC Pediatr 2021; 21:296. [PMID: 34210267 PMCID: PMC8247172 DOI: 10.1186/s12887-021-02751-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/26/2021] [Indexed: 11/11/2022] Open
Abstract
Background Newborn screening (NBS) for sickle cell disease incidentally identifies heterozygous carriers of hemoglobinopathy mutations. In Ontario, Canada, these carrier results are not routinely disclosed, presenting an opportunity to investigate the potential health implications of carrier status. We aimed to compare rates of health services use among children identified as carriers of hemoglobinopathy mutations and those who received negative NBS results. Methods Eligible children underwent NBS in Ontario from October 2006 to March 2010 and were identified as carriers or as screen-negative controls, matched to carriers 5:1 based on neighbourhood and timing of birth. We used health care administrative data to determine frequencies of inpatient hospitalizations, emergency department (ED) visits, and physician encounters through March 2012, using multivariable negative binomial regression to compare rates of service use in the two cohorts. We analyzed data from 4987 carriers and 24,935 controls. Results Adjusted incidence rate ratios (95% CI) for service use in carriers versus controls among children < 1 year of age were: 1.11 (1.06–1.17) for ED visits; 0.97 (0.89–1.06) for inpatient hospitalization; and 1.02 (1.00–1.04) for physician encounters. Among children ≥1 year of age, adjusted rate ratios were: 1.03 (0.98–1.07) for ED visits; 1.14 (1.03–1.25) for inpatient hospitalization and 0.92 (0.90–0.94) for physician encounters. Conclusions While we identified statistically significant differences in health services use among carriers of hemoglobinopathy mutations relative to controls, effect sizes were small and directions of association inconsistent across age groups and health service types. Our findings are consistent with the assumption that carrier status is likely benign in early childhood.
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Affiliation(s)
- Sara D Khangura
- School of Epidemiology and Public Health, University of Ottawa, 415 Smyth Road, Ottawa, Ontario, K1H 8M8, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, 415 Smyth Road, Ottawa, Ontario, K1H 8M8, Canada.,Newborn Screening Ontario, Ottawa, Ontario, Canada.,ICES, University of Ottawa campus, Ottawa, Ontario, Canada
| | | | - Robin Ducharme
- ICES, University of Ottawa campus, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - A Brianne Bota
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Steven Hawken
- School of Epidemiology and Public Health, University of Ottawa, 415 Smyth Road, Ottawa, Ontario, K1H 8M8, Canada.,ICES, University of Ottawa campus, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- School of Epidemiology and Public Health, University of Ottawa, 415 Smyth Road, Ottawa, Ontario, K1H 8M8, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Maria D Karaceper
- School of Epidemiology and Public Health, University of Ottawa, 415 Smyth Road, Ottawa, Ontario, K1H 8M8, Canada.,Newborn Screening Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert J Klaassen
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, 415 Smyth Road, Ottawa, Ontario, K1H 8M8, Canada
| | - Ewurabena Simpson
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Ottawa, Ontario, Canada. .,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. .,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
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17
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Sun HL, Yang M, Poon MC, Lee A, Robinson KS, Sholzberg M, Wu J, Iorio A, Blanchette V, Carcao M, Klaassen RJ, Jackson S. Factor product utilization and health outcomes in patients with haemophilia A and B on extended half-life concentrates: A Canadian observational study of real-world outcomes. Haemophilia 2021; 27:751-759. [PMID: 34160870 DOI: 10.1111/hae.14369] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 03/19/2021] [Revised: 05/31/2021] [Accepted: 06/13/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Recombinant factors VIII and IX Fc (rFVIIIFc/rFIXFc) became available in Canada in 2016 and were the only extended half-life (EHL) factor concentrates available in Canada until 2018. OBJECTIVES We aim to describe the change in product utilization in Canadians who switched to rFVIIIFc/rFIXFc. METHODS This prospective and retrospective cohort study enrolled males aged ≥6 years with moderate or severe haemophilia who switched to rFVIIIFc/rFIXFc and those who remained on standard half-life (SHL) between 2016 and 2018. Factor utilization and annualized bleeding rates (ABR) were collected at baseline, 1-year and 2-years. Due to low prospective enrolment (n = 25 switchers), prospective and retrospective data were pooled. RESULTS 125 switchers (93 rFVIIIFc, 32 rFIXFc) and 33 non-switchers were included. The median age was 17 (rFVIIIFc) and 38 years (rFIXFc). Prior to switch, over 80% were on prophylaxis. There was a statistically significant reduction in the prescribed weekly prophylactic dose after the switch to rFVIIIFc/rFIXFc for all age groups, with a corresponding reduction (15-16%) in actual annualized FIX utilization in switchers (combined adults and children) to rFIXFc, and a smaller non-significant reduction in actual annualized FVIIII utilization (7%) in children who switched to rFVIIIFc. A significant reduction in the median ABR was only observed in children who switched to rFVIIIFc, but not in adults who switched to rFVIIIFc or rFIXFc. CONCLUSION Switching from SHL to EHL products led to a small reduction in factor utilization, while preserving a low ABR in children and adults with haemophilia. Further patient-reported outcomes data will further elucidate the role of EHL in the haemophilia landscape.
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Affiliation(s)
- Haowei Linda Sun
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ming Yang
- British Columbia Hemophilia Treatment Centre - Adult Division, Vancouver, British Columbia, Canada
| | - Man-Chiu Poon
- Department of Medicine, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adrienne Lee
- Department of Medicine, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - K Sue Robinson
- Division of Hematology, Department of Medicine, University of Dalhousie, Halifax, Nova Scotia, Canada
| | - Michelle Sholzberg
- Division of Hematology, Departments of Medicine and Laboratory Medicine & Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - John Wu
- Division of Hematology Oncology, British Columbia Children and Women's Hospital, Vancouver, British Columbia, Canada
| | - Alfonso Iorio
- Division of Hematology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Victor Blanchette
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Manuel Carcao
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Robert J Klaassen
- Division of Hematology Oncology, Department of Pediatrics, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Shannon Jackson
- British Columbia Hemophilia Treatment Centre - Adult Division, Vancouver, British Columbia, Canada.,Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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18
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Shimano KA, Neunert C, Bussel JB, Klaassen RJ, Bhat R, Pastore YD, Lambert MP, Bennett CM, Despotovic JM, Forbes P, Grace RF. Quality of life is an important indication for second-line treatment in children with immune thrombocytopenia. Pediatr Blood Cancer 2021; 68:e29023. [PMID: 33764667 DOI: 10.1002/pbc.29023] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND The decision to initiate second-line treatment in children with immune thrombocytopenia (ITP) is complex and involves many different factors. METHODS In this prospective, observational, longitudinal cohort study of 120 children from 21 centers, the factors contributing to the decision to start second-line treatments for ITP were captured. At study entry, clinicians were given a curated list of 12 potential reasons the patient required a second-line treatment. Clinicians selected all that applied and ranked the top three reasons. RESULTS Quality of life (QOL) was the most frequently cited reason for starting a second-line therapy. Clinicians chose it as a reason to treat in 88/120 (73%) patients, as among the top three reasons in 68/120 (57%), and as the top reason in 32/120 (27%). Additional factors ranked as the top reason to start second-line treatment included severity of bleeding (22/120, 18%), frequency of bleeding (19/120, 16%), and severity of thrombocytopenia (18/120, 15%). Patients for whom QOL (p = .006) or sports participation (p = .02) were ranked reasons were more likely to have chronic ITP, whereas those for whom severity (p = .003) or frequency (p = .005) of bleeding were ranked reasons were more likely to have newly diagnosed or persistent ITP. Parental anxiety, though rarely the primary impetus for treatment, was frequently cited (70/120, 58%) as a contributing factor. CONCLUSION Perceived QOL is the most frequently selected reason pediatric patients start second-line therapies for ITP. It is critical that studies of treatments for childhood ITP include assessments of their effects on QOL.
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Affiliation(s)
| | - Cindy Neunert
- Columbia University Medical Center, New York, New York, USA
| | | | | | - Rukhmi Bhat
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Michele P Lambert
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Carolyn M Bennett
- Emory University School of Medicine, Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, Georgia, USA
| | - Jenny M Despotovic
- Texas Children's Hematology Center, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Forbes
- Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rachael F Grace
- Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Boston, Massachusetts, USA
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19
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Goren R, Pullenayegum E, Blanchette VS, Dover S, Carcao M, Israels SJ, Chan A, Rivard GE, Steele M, Cloutier S, Klaassen RJ, Sinha R, Price VE, Laferriere N, Paradis E, Wu JK, Feldman BM. Patterns of joint damage in severe haemophilia A treated with prophylaxis. Haemophilia 2021; 27:666-673. [PMID: 34015166 DOI: 10.1111/hae.14345] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The primary objective of this study was to assess whether there are different patterns (classes) of joint health in young boys with severe haemophilia A (SHA) prescribed primary tailored prophylaxis. We also assessed whether age at first index joint bleed, blood group, FVIII gene abnormality variant, factor VIII trough level, first-year bleeding rate and adherence to the prescribed prophylaxis regimen significantly predicted joint damage trajectory, and thus class membership. METHODS Using data collected prospectively as part of the Canadian Hemophilia Primary Prophylaxis Study (CHPS), we implemented a latent class growth mixture model technique to determine how many joint damage classes existed within the cohort. We used a multinomial logistic regression to predict the odds of class membership based on the above predictors. We fitted a survival model to assess whether there were differences in the rate of dose escalation across the groups. RESULTS We identified three distinct classes of trajectory: persistently low, moderately increasing and rapidly increasing joint scores. By multinomial regression, we found that only age at first index joint bleed predicted rapidly increasing joint scores. The rapidly increasing joint score class group moved through dose escalation significantly faster than the other two groups. CONCLUSIONS Using tailored prophylaxis, boys with SHA follow one of three joint health trajectories. By using knowledge of disease trajectories, clinicians may be able to adjust treatment according to a subject's predicted long-term joint health and institute cost-effective programmes of prophylaxis targeted at the individual subject level.
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Affiliation(s)
- Rachel Goren
- Institute of Health Policy, Management & Evaluation, The Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- Institute of Health Policy, Management & Evaluation, The Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Victor S Blanchette
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Saunya Dover
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Manuel Carcao
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sara J Israels
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Anthony Chan
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Georges E Rivard
- Division of Hematology/Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - MacGregor Steele
- Section of Pediatric Hematology, Department of Pediatrics, University of Calgary and Alberta Children's Hospital, Calgary, AB, Canada
| | - Stéphanie Cloutier
- Centre de l'hémophilie de l'est du Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, QC, Canada
| | - Robert J Klaassen
- Division of Pediatric Hematology/Oncology, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Roona Sinha
- Saskatchewan Bleeding Disorders Program, Royal University Hospital, Saskatoon, SK, Canada
| | - Victoria E Price
- Division of Pediatric Hematology/Oncology, IWK Health Centre, Halifax, NS, Canada
| | - Nicole Laferriere
- Division of Hematology/Oncology, Thunder Bay Regional Cancer Care, Thunder Bay, ON, Canada
| | | | - John K Wu
- Division of Hematology/Oncology/BMT, Department of Pediatrics, UBC & BC Children's Hospital, Vancouver, BC, Canada
| | - Brian M Feldman
- Institute of Health Policy, Management & Evaluation, The Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada
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20
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Dover S, Young NL, Blanchette VS, Klaassen RJ, Chan AK, Wakefield C, Bouskill V, Carcao M, Belletrutti M, Bruce AAK, Price VE. Measuring the impact of hemophilia on families: Development of the Hemophilia Family Impact Tool (H-FIT). Res Pract Thromb Haemost 2021; 5:e12519. [PMID: 34013152 PMCID: PMC8114030 DOI: 10.1002/rth2.12519] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction This study aimed to assess the impact of hemophilia on families, in the context of current and emerging hemostatic therapies, and explore the need for a hemophilia‐specific tool targeted at parents of boys aged <4 years. A secondary aim was to develop and validate the new tool. Methods Focus groups were conducted with parents of boys with hemophilia and hemophilia health care providers at Canadian hemophilia treatment centers (HTCs) to review the relevance of the Pediatric Quality of Life Family Impact Module (PedsQL‐FIM); a novel questionnaire was developed by identifying core themes expressed. This questionnaire, the Hemophilia Family Impact Tool (H‐FIT) was validated in a sample of parents of boys with hemophilia relative to the PedsQL‐FIM. Results Seven focus groups were conducted at four HTCs, generating themes specific to hemophilia not covered by the PedsQL‐FIM, suggesting that a new tool be developed (the H‐FIT). In the validation phase, 54 parents completed the H‐FIT and PedsQL‐FIM. The H‐FIT had a strong correlation with the PedsQL‐FIM across all ages (r = 0.79; P < .0001) and a moderate correlation for parents of boys aged <7 years (r = 0.64; P = .0007). There was a significant difference between the mean H‐FIT scores for parents of boys using extended half‐life factor (68.1; standard deviation [SD]=14.2) compared to standard half‐life factor (54.7; SD=18.4; P = .04). Conclusion A novel, disease‐specific tool, the H‐FIT, has been developed to measure the impact of hemophilia on families. The H‐FIT has good preliminary measurement properties and may be responsive to changes in therapy associated with a decreased burden of administration.
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Affiliation(s)
- Saunya Dover
- Child Health Evaluative Sciences The Hospital for Sick Children Research Institute Toronto ON Canada
| | - Nancy L Young
- School of Rural and Northern Health Laurentian University Sudbury ON Canada
| | - Victor S Blanchette
- Child Health Evaluative Sciences The Hospital for Sick Children Research Institute Toronto ON Canada.,Division of Hematology/Oncology The Hospital for Sick Children Toronto ON Canada.,Department of Pediatrics University of Toronto Toronto ON Canada
| | - Robert J Klaassen
- Division of Pediatric Hematology/Oncology University of Ottawa Children's Hospital of Eastern Ontario Ottawa ON Canada
| | - Anthony K Chan
- Department of Pediatrics McMaster Children's Hospital McMaster University Hamilton ON Canada
| | - Cindy Wakefield
- Department of Nursing The Hospital for Sick Children Toronto ON Canada
| | - Vanessa Bouskill
- Division of Hematology/Oncology The Hospital for Sick Children Toronto ON Canada.,Department of Nursing The Hospital for Sick Children Toronto ON Canada
| | - Manuel Carcao
- Child Health Evaluative Sciences The Hospital for Sick Children Research Institute Toronto ON Canada.,Division of Hematology/Oncology The Hospital for Sick Children Toronto ON Canada.,Department of Pediatrics University of Toronto Toronto ON Canada
| | - Mark Belletrutti
- Pediatric Hematology Department of Pediatrics University of Alberta Edmonton AB Canada
| | - Aisha A K Bruce
- Pediatric Hematology Department of Pediatrics University of Alberta Edmonton AB Canada
| | - Victoria E Price
- Division of Pediatric Hematology/Oncology Department of Pediatrics IWK Health Centre Dalhousie University Halifax NS Canada
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21
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Kinahan JY, Graham JMI, Hébert YV, Sampson M, O'Hearn K, Klaassen RJ. Patient-reported Outcome Measures in Pediatric Non-Malignant Hematology: A Systematic Review. J Pediatr Hematol Oncol 2021; 43:121-134. [PMID: 33136776 DOI: 10.1097/mph.0000000000001984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/28/2020] [Indexed: 01/19/2023]
Abstract
Patient-reported outcome measures (PROMs) are questionnaires completed by patients or caregivers without influence by health care professionals. As such, PROMs show subjective health experiences, enhance the clinical information available to providers, and inform clinical action. The objective of this systematic review is to identify and list which validated PROMs have been used to monitor health-related quality of life in pediatric patients with nonmalignant hematology (hemophilia, immune thrombocytopenia, sickle cell disease, and thalassemia). Databases (MEDLINE, Embase, HaPI, CINAHL, and PsycTESTS) were searched to identify publications that validated or used PROMs as an outcome measure in the 4 disease groups. Overall, 209 articles met the inclusion criteria, identifying 113 PROMs. Of the 113 identified PROMs, 95 are generic and can be used in multiple disease groups. The Pediatric Quality of Life Generic Core Scales was the most frequently used generic PROM (68 studies). The 18 remaining PROMs were disease specific. The results of this review, together with the COSMIN tool for selecting outcome measures, will allow clinicians to evaluate the PROMs that are best suited to their patient population. In addition, the focus groups are currently being conducted with patients, parents, and clinicians to determine the optimal use of PROMs in the clinical environment.
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Affiliation(s)
- Julia Y Kinahan
- Children's Hospital of Eastern Ontario Research Institute
- University of Ottawa, Ottawa, ON
| | - Johann M I Graham
- Children's Hospital of Eastern Ontario Research Institute
- Regional Hospital Center of Lanaudiere, Saint-Charles-Borromée
- Laval University, Quebec City, QC, Canada
| | - Yamilée V Hébert
- Children's Hospital of Eastern Ontario Research Institute
- University of Ottawa, Ottawa, ON
| | | | - Katie O'Hearn
- Children's Hospital of Eastern Ontario Research Institute
| | - Robert J Klaassen
- Children's Hospital of Eastern Ontario Research Institute
- Division of Hematology/Oncology, Department of Pediatrics
- University of Ottawa, Ottawa, ON
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22
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Do J, Blais A, Feldman B, Brandão LR, Lougheed J, Pohl D, Klaassen RJ, Johnston DL, De Laat D, Roth J, Katz SL, McCormick A, Wright FV, Macartney G, McMillan HJ, Venkateswaran S, Sell E, Doja A, Matheson K, Boafo A, Longmuir PE. Characterization of physical literacy in children with chronic medical conditions compared with healthy controls: a cross-sectional study. Appl Physiol Nutr Metab 2021; 46:1073-1082. [PMID: 33689492 DOI: 10.1139/apnm-2020-0957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To determine the physical literacy, defined as the capability for a physically active lifestyle, of children with medical conditions compared with healthy peers, this multicenter cross-sectional study recruited children with medical conditions from cardiology, neurology (including concussion), rheumatology, mental health, respirology, oncology, hematology, and rehabilitation (including cerebral palsy) clinics. Participants aged 8-12 years (N = 130; mean age: 10.0 ± 1.44 years; 44% female) were randomly matched to 3 healthy peers from a normative database, based on age, gender, and month of testing. Total physical literacy was assessed by the Canadian Assessment of Physical Literacy, a validated assessment of physical literacy measuring physical competence, daily behaviour, knowledge/understanding, and motivation/confidence. Total physical literacy mean scores (/100) did not differ (t(498) = -0.67; p = 0.44) between participants (61.0 ± 14.2) and matched healthy peers (62.0 ± 10.7). Children with medical conditions had lower mean physical competence scores (/30; -6.5 [-7.44 to -5.51]; p < 0.001) but higher mean motivation/confidence scores (/30; 2.6 [1.67 to 3.63]; p < 0.001). Mean daily behaviour and knowledge/understanding scores did not differ from matches (/30; 1.8 [0.26 to 3.33]; p = 0.02;/10; -0.04 [-0.38 to 0.30]; p = 0.81; respectively). Children with medical conditions are motivated to be physically active but demonstrate impaired movement skills and fitness, suggesting the need for targeted interventions to improve their physical competence. Novelty: Physical literacy in children with diverse chronic medical conditions is similar to healthy peers. Children with medical conditions have lower physical competence than healthy peers, but higher motivation and confidence. Physical competence (motor skill, fitness) interventions, rather than motivation or education, are needed for these youth.
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Affiliation(s)
- Jeffrey Do
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Angelica Blais
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Brian Feldman
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Leonardo R Brandão
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jane Lougheed
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Daniela Pohl
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Robert J Klaassen
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Donna L Johnston
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Denise De Laat
- Division of Developmental Pediatrics and Rehabilitation Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Johannes Roth
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sherri Lynne Katz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Respirology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Anna McCormick
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Developmental Pediatrics and Rehabilitation Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - F Virginia Wright
- Holland Bloorview Children's Rehab Hospital, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Ottawa, ON, Canada
| | - Gail Macartney
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Faculty of Nursing, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - Hugh J McMillan
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sunita Venkateswaran
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Erick Sell
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Asif Doja
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Katherine Matheson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Addo Boafo
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Patricia E Longmuir
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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23
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Price VE, Dover S, Blanchette VS, Klaassen RJ, Belletrutti M, Bruce AAK, Chan AK, Wakefield C, Carcao M, Bouskill V, Young NL. Updating the Canadian Hemophilia Outcomes-Kids' Life Assessment Tool (CHO-KLAT) in the era of extended half-life clotting factor concentrates. Res Pract Thromb Haemost 2021; 5:403-411. [PMID: 33870026 PMCID: PMC8035800 DOI: 10.1002/rth2.12498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The purpose of this study was to review and update the content of the Canadian Hemophilia Outcomes-Kids' Life Assessment Tool version 2.0 (CHO-KLAT), in the context of extended half-life (EHL) factor concentrates (FCs) and to establish the validity and reliability of the updated CHO-KLAT. METHODS Focus groups were conducted with boys with hemophilia, their parents, and health care providers across Canada to review the CHO-KLAT v2.0 and determine if any modifications were required. The validity of the revised CHO-KLAT (version 3.0) was then determined in a sample of boys with hemophilia and their parents by calculating its correlation with the Pediatric Quality of Life Core Module (PedsQL-Core). Test-retest reliability was assessed using an intraclass correlation coefficient (ICC). RESULTS Thirteen focus groups at 5 pediatric hemophilia treatment centers (HTCs) (n = 71) resulted in 19 changes to the CHO-KLAT v2.0, generating a revised 40-item CHO-KLAT, the CHO-KLAT v3.0. Thirty-five boys with hemophilia (median age, 14; range, 7-17 years) and 47 parents participated in the validation of the CHO-KLAT v3.0. There was a moderate correlation between the CHO-KLAT v3.0 child self-report and PedsQL-Core (r = 0.56, P = .01), and a strong correlation between the CHO-KLAT v3.0 parent-proxy and PedsQL-Core (r = .79, P = .0007). The test-retest reliability ICC was 0.90 for the child self-report CHO-KLAT v3.0 and 0.68 for the parent-proxy CHO-KLAT v3.0. CONCLUSION The CHO-KLAT v3.0 is a reliable and valid child-centric tool that effectively measures health-related quality of life in boys with hemophilia who are receiving standard half-life or EHL FCs.
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Affiliation(s)
- Victoria E. Price
- Department of PediatricsDivision of Pediatric Hematology/OncologyIWK Health CentreDalhousie UniversityHalifaxNSCanada
| | - Saunya Dover
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
| | - Victor S. Blanchette
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
| | - Robert J. Klaassen
- Division of Pediatric Hematology/OncologyUniversity of OttawaChildren’s Hospital of Eastern OntarioOttawaONCanada
| | - Mark Belletrutti
- Department of PediatricsPediatric HematologyUniversity of AlbertaEdmontonABCanada
| | - Aisha A. K. Bruce
- Department of PediatricsPediatric HematologyUniversity of AlbertaEdmontonABCanada
| | - Anthony K. Chan
- Department of PediatricsMcMaster Children’s HospitalMcMaster UniversityHamiltonONCanada
| | - Cindy Wakefield
- Department of NursingThe Hospital for Sick ChildrenTorontoONCanada
| | - Manuel Carcao
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
| | - Vanessa Bouskill
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
- Department of NursingThe Hospital for Sick ChildrenTorontoONCanada
| | - Nancy L. Young
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
- School of Rural and Northern HealthLaurentian UniversitySudburyONCanada
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24
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Johnston K, Stoffman JM, Mickle AT, Klaassen RJ, Diles D, Olatunde S, Eliasson L, Bahar R. Preferences and Health-Related Quality-of-Life Related to Disease and Treatment Features for Patients with Hemophilia A in a Canadian General Population Sample. Patient Prefer Adherence 2021; 15:1407-1417. [PMID: 34194224 PMCID: PMC8238543 DOI: 10.2147/ppa.s316276] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Current treatments for hemophilia A in Canada include on-demand treatment as bleeds occur and regular intravenous prophylactic factor VIII (FVIII) infusions. The subcutaneous therapy emicizumab was recently approved for treatment of hemophilia A. The objective of this study was to estimate utility values associated with hemophilia A health and treatment states from a Canadian societal perspective, including preferences related to treatment efficacy and frequency and route of administration. METHODS A vignette-based time trade-off (TTO) utilities elicitation was undertaken in Canadian adults to compare preferences for six hemophilia health states describing prophylactic and on-demand treatment, with varying bleed rates and frequency of treatment administration. A convenience sample was recruited via market research panels and snowball sampling. Health state/vignette definitions were informed by clinical experience, clinical trial results regarding bleed frequency, and validated by qualitative interviews of hemophilia patients and caregivers (n=10). Utilities were estimated via an online, trained interviewer-guided, vignette-based TTO exercise, where respondents valuated health states describing hemophilia patients (adults or children) receiving subcutaneous prophylaxis, intravenous prophylaxis, and on-demand treatments. Analyses included a descriptive analysis by health state; a mixed-effects analysis of utility values adjusted for subcutaneous vs infusion-based therapies and number of bleeds; and for prophylactic regimens, an analysis of utilities by frequency of infusions or injections. RESULTS TTO interviews were conducted with 82 respondents. Mean utilities [95% CI] were highest for subcutaneous prophylaxis (0.90 [0.87-0.93]), followed by intravenous prophylaxis (0.81 [0.78-0.85]), and on-demand treatment (0.70 [0.65-0.76]). In regression analysis, subcutaneous treatment health states were associated with a utility increment of +0.1112. Additional bleeds and more frequent infusions were associated with lower utility values (-0.0027 per bleed and -0.0003 per infusion). CONCLUSION Subcutaneous prophylaxis is associated with higher utility values compared to intravenous prophylactic and on-demand treatment, while increased bleeds and infusions are associated with reduced utility.
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Affiliation(s)
- Karissa Johnston
- Broadstreet HEOR, Vancouver, BC, Canada
- School of Pharmacy, Memorial University, St John’s, NL, Canada
- Correspondence: Karissa Johnston Broadstreet Health Economics and Outcomes Research, 201–343 Railway Street, Vancouver, BCV6A 1A4, Canada Email
| | - Jayson M Stoffman
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Robert J Klaassen
- Department of Pediatrics, Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Demitri Diles
- Hoffmann-La Roche Limited, Mississauga, ON, L5N 5M8, Canada
| | - Shade Olatunde
- Hoffmann-La Roche Limited, Mississauga, ON, L5N 5M8, Canada
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25
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Grace RF, Klaassen RJ, Shimano KA, Lambert MP, Grimes A, Bussel JB, Breakey VR, Pastore YD, Black V, Overholt K, Bhat R, Forbes PW, Neunert C. Fatigue in children and adolescents with immune thrombocytopenia. Br J Haematol 2020; 191:98-106. [PMID: 32501532 DOI: 10.1111/bjh.16751] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 03/06/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 01/19/2023]
Abstract
Immune thrombocytopenia (ITP), an acquired autoimmune disorder of low platelets and risk of bleeding, has a substantial impact on health-related quality of life (HRQoL). Patients with ITP often report significant fatigue, although the pathophysiology of this is poorly understood. In this observational cohort of 120 children receiving second-line therapies for ITP, we assessed reports of fatigue using the Hockenberry Fatigue Scale. Children and adolescents with ITP reported a similarly high level of fatigue with 54% (29/54) of children and 62% (26/42) of adolescents reporting moderate-to-severe fatigue. There was no correlation between fatigue and age or gender. Adolescents with newly diagnosed and persistent ITP had higher mean fatigue scores than those with chronic ITP (P = 0·03). Fatigue significantly improved in children and adolescents by 1 month after starting second-line treatments, and this improvement continued to be present at 12 months after starting treatment. Fatigue scores at all time-points correlated with general HRQoL using the Kids ITP Tool, but did not correlate with bleeding symptoms, platelet count, or platelet response to treatment. Fatigue is common in children and adolescents with ITP and may benefit from ITP-directed treatment even in the absence of bleeding symptoms.
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Affiliation(s)
- Rachael F Grace
- Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA
| | - Robert J Klaassen
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Kristin A Shimano
- Division of Allergy/Immunology/Bone Marrow Transplant, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Michele P Lambert
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amanda Grimes
- Baylor College of Medicine, Texas Children's Cancer and Hematology Center, Houston, TX, USA
| | | | | | | | - Vandy Black
- Division of Pediatric Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Kathleen Overholt
- Riley Hospital at IU Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rukhmi Bhat
- Ann and Robert H. Lurie Childrens Hospital of Chicago, Chicago, IL, USA
| | - Peter W Forbes
- Clinical Research Center, Boston Children's Hospital, Boston, MA, USA
| | - Cindy Neunert
- Columbia University Medical School, New York, NY, USA
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26
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Català A, Ali SS, Cuvelier GDE, Steele M, Klaassen RJ, Fernandez CV, Pastore YD, Abish S, Rayar M, Jardine L, Breakey VR, Brossard J, Sinha R, Silva M, Goodyear L, Lipton JH, Michon B, Corriveau-Bourque C, Sung L, Lauhasurayotin S, Zlateska B, Cada M, Dror Y. Androgen therapy in inherited bone marrow failure syndromes: analysis from the Canadian Inherited Marrow Failure Registry. Br J Haematol 2020; 189:976-981. [PMID: 32128787 DOI: 10.1111/bjh.16445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/17/2019] [Accepted: 11/21/2019] [Indexed: 11/29/2022]
Abstract
Progressive cytopenia is a serious complication among paediatric patients with inherited bone marrow failure syndromes (IBMFS). Androgens have been used to improve blood counts in different bone marrow failure conditions. Little is known about efficacy and toxicity with new androgens (i.e., danazol) in different types of IBMFS. We identified 29 patients from the Canadian Inherited Marrow Failure Registry, who received oxymetholone or danazol. Sixteen (55%) had haematological response including patients with unclassified IBMFS (45%). Danazol showed a better toxicity profile and similar efficacy compared to oxymetholone. Androgens are an effective and safe option to ameliorate bone marrow failure in IBMFS.
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Affiliation(s)
- Albert Català
- Division of Hematology/Oncology, Department of Pediatrics, Marrow Failure and Myelodysplasia Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Salah S Ali
- Bone Marrow Transplantation and Cellular Therapy, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Geoffrey D E Cuvelier
- Pediatric Hematology-Oncology-Blood and Marrow Transplantation, University of Manitoba, CancerCare Manitoba, Winnipeg, MB, Canada
| | | | - Robert J Klaassen
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | | | - Sharon Abish
- Pediatric Hematology Oncology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Meera Rayar
- Division of Hematology/Oncology, UBC & B.C. Children's Hospital, Vancouver, BC, Canada
| | - Lawrence Jardine
- Children's Hospital, London Health Sciences Centre, London, ON, Canada
| | - Vicky R Breakey
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Josee Brossard
- Centre Hospitalier Universitaire, Sherbrooke, QC, Canada
| | - Roona Sinha
- Royal University Hospital, Saskatoon, SK, Canada
| | | | - Lisa Goodyear
- Pediatric Hematology/Oncology, Janeway Child Health Centre, St. John's, NF, Canada
| | - Jeffrey H Lipton
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Bruno Michon
- Centre Hospitalier Universitaire de Quebec, Sainte-Foy, QC, Canada
| | | | - Lillian Sung
- Division of Hematology/Oncology, Department of Pediatrics, Child and Population Health Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Supanun Lauhasurayotin
- Division of Hematology/Oncology, Department of Pediatrics, Marrow Failure and Myelodysplasia Program, The Hospital for Sick Children, Toronto, ON, Canada.,Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bozana Zlateska
- Division of Hematology/Oncology, Department of Pediatrics, Marrow Failure and Myelodysplasia Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michaela Cada
- Division of Hematology/Oncology, Department of Pediatrics, Marrow Failure and Myelodysplasia Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Yigal Dror
- Division of Hematology/Oncology, Department of Pediatrics, Marrow Failure and Myelodysplasia Program, The Hospital for Sick Children, Toronto, ON, Canada.,Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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27
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Heidemann S, Bursic B, Zandi S, Li H, Abelson S, Klaassen RJ, Abish S, Rayar M, Breakey VR, Moshiri H, Dhanraj S, de Borja R, Shlien A, Dick JE, Dror Y. Cellular and molecular architecture of hematopoietic stem cells and progenitors in genetic models of bone marrow failure. JCI Insight 2020; 5:131018. [PMID: 31990679 DOI: 10.1172/jci.insight.131018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/18/2019] [Accepted: 01/15/2020] [Indexed: 12/26/2022] Open
Abstract
Inherited bone marrow failure syndromes, such as Fanconi anemia (FA) and Shwachman-Diamond syndrome (SDS), feature progressive cytopenia and a risk of acute myeloid leukemia (AML). Using deep phenotypic analysis of early progenitors in FA/SDS bone marrow samples, we revealed selective survival of progenitors that phenotypically resembled granulocyte-monocyte progenitors (GMP). Whole-exome and targeted sequencing of GMP-like cells in leukemia-free patients revealed a higher mutation load than in healthy controls and molecular changes that are characteristic of AML: increased G>A/C>T variants, decreased A>G/T>C variants, increased trinucleotide mutations at Xp(C>T)pT, and decreased mutation rates at Xp(C>T)pG sites compared with other Xp(C>T)pX sites and enrichment for Cancer Signature 1 (X indicates any nucleotide). Potential preleukemic targets in the GMP-like cells from patients with FA/SDS included SYNE1, DST, HUWE1, LRP2, NOTCH2, and TP53. Serial analysis of GMPs from an SDS patient who progressed to leukemia revealed a gradual increase in mutational burden, enrichment of G>A/C>T signature, and emergence of new clones. Interestingly, the molecular signature of marrow cells from 2 FA/SDS patients with leukemia was similar to that of FA/SDS patients without transformation. The predicted founding clones in SDS-derived AML harbored mutations in several genes, including TP53, while in FA-derived AML the mutated genes included ARID1B and SFPQ. We describe an architectural change in the hematopoietic hierarchy of FA/SDS with remarkable preservation of GMP-like populations harboring unique mutation signatures. GMP-like cells might represent a cellular reservoir for clonal evolution.
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Affiliation(s)
- Stephanie Heidemann
- Genetics & Genome Biology Program and.,Marrow Failure and Myelodysplasia (Pre-leukemia) Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Sasan Zandi
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Sagi Abelson
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Robert J Klaassen
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sharon Abish
- Hematology-Oncology, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Meera Rayar
- Division of Hematology, Oncology & Bone Marrow Transplant, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Vicky R Breakey
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Santhosh Dhanraj
- Genetics & Genome Biology Program and.,Institute of Medical Science and
| | | | | | - John E Dick
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Yigal Dror
- Genetics & Genome Biology Program and.,Marrow Failure and Myelodysplasia (Pre-leukemia) Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science and
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28
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Dover S, Blanchette VS, Wrathall D, Pullenayegum E, Kazandjian D, Song B, Hawes SA, Cloutier S, Rivard GE, Klaassen RJ, Paradis E, Laferriere N, Stain AM, Chan AK, Israels SJ, Sinha R, Steele M, Wu JKM, Feldman BM. Hemophilia prophylaxis adherence and bleeding using a tailored, frequency-escalated approach: The Canadian Hemophilia Primary Prophylaxis Study. Res Pract Thromb Haemost 2020; 4:318-325. [PMID: 32110763 PMCID: PMC7040543 DOI: 10.1002/rth2.12301] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Standard of care for persons with severe hemophilia A includes regular replacement of factor VIII (FVIII). Prophylaxis regimens using standard half-life (SHL) FVIII concentrates, while effective, are costly and require frequent intravenous infusions. AIM This study evaluated the adherence of 56 boys with severe hemophilia A to tailored, frequency-escalated prophylaxis with an SHL recombinant FVIII concentrate. METHODS We reviewed the factor infusion and bleeding logs of study subjects. Adherence to the prescribed regimen was calculated on a weekly basis, and bleeding rates were determined from self/proxy-reported bleeding logs. The primary outcome was adherence to the prescribed prophylaxis regimen. RESULTS The median (range of values [ROV]) weekly adherence to prophylaxis was 85.7% (37.4%-99.8%). The median (ROV) adherent weeks on steps 1 (weekly), 2 (twice weekly), and 3 (alternate-day) were 92.9% (50%-100%), 80.3 (32%-96%), and 72.6% (14%-98%); relative to step 1, subjects were less likely to be adherent on steps 2 and 3 (P < 0.00). On step 1, our cohort had higher adherence than previously reported rates. The median (ROV) adherence to the breakthrough bleeding protocol was 47.1% (0%-100%). At any given time, bleeding risk was reduced by 15% for each 10% increase in adherence during the preceding 12 weeks (hazard ratio, 0.85; 95% confidence interval, 0.81-0.90). CONCLUSION This cohort had high rates of adherence to the prescribed prophylaxis regimen. Initiating prophylaxis with once-weekly infusions facilitated adherence to the prophylaxis regimen in this cohort of boys with severe hemophilia A started on primary prophylaxis at a very young age.
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Affiliation(s)
- Saunya Dover
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
| | - Victor S. Blanchette
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
- Department of PediatricsFaculty of MedicineUniversity of TorontoTorontoONCanada
| | - Darius Wrathall
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
| | - Eleanor Pullenayegum
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
- Institute of Health Policy, Management and Evaluationthe Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
| | - Daniel Kazandjian
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
| | - Byron Song
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
| | - Sue Ann Hawes
- Division of Pediatric Hematology/OncologyIWK Health CentreHalifaxNSCanada
| | - Stéphanie Cloutier
- Centre de l'hémophilie de l'est du QuébecHôpital de l’Enfant‐JésusUniversité LavalQuébecQCCanada
| | - Geroges E. Rivard
- Division of Hematology/OncologyDepartment of PediatricsCHU Sainte‐JustineMontrealQCCanada
| | - Robert J. Klaassen
- Division of Pediatric Hematology/OncologyChildren’s Hospital of Eastern OntarioUniversity of OttawaOttawaONCanada
| | | | - Nicole Laferriere
- Division of Hematology/OncologyThunder Bay Regional Cancer CareThunder BayONCanada
| | - Ann Marie Stain
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
| | - Anthony K. Chan
- Department of PediatricsMcMaster Children’s HospitalMcMaster UniversityHamiltonONCanada
| | - Sara J. Israels
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegMBCanada
| | - Roona Sinha
- Saskatchewan Bleeding Disorders ProgramRoyal University HospitalSaskatoonSKCanada
| | - MacGregor Steele
- Section of Pediatric HematologyDepartment of PediatricsUniversity of Calgary and Alberta Children’s HospitalCalgaryABCanada
| | - John K. M. Wu
- Division of Hematology/Oncology/BMTDepartment of PediatricsUBC & BC Children’s HospitalVancouverBCCanada
| | - Brian M. Feldman
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
- Department of PediatricsFaculty of MedicineUniversity of TorontoTorontoONCanada
- Institute of Health Policy, Management and Evaluationthe Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
- Division of RheumatologyThe Hospital for Sick ChildrenTorontoONCanada
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29
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Salek S, Boscoe AN, Piantedosi S, Egan S, Evans CJ, Wells T, Cohen J, Klaassen RJ, Grace R, Storm M. Development of the pyruvate kinase deficiency diary and pyruvate kinase deficiency impact assessment: Disease-specific assessments. Eur J Haematol 2019; 104:427-434. [PMID: 31880847 PMCID: PMC7216839 DOI: 10.1111/ejh.13376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/05/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 01/19/2023]
Abstract
Introduction Currently recommended patient‐reported outcome (PRO) measures for patients with pyruvate kinase (PK) deficiency are non‐disease‐specific. The PK Deficiency Diary (PKDD) and PK Deficiency Impact Assessment (PKDIA) were developed to be more targeted measures for capturing the symptoms and impacts of interest to this patient population. Methods The instruments were developed based on concept elicitation interviews with 21 adults and modified based on 20 cognitive interviews. The domain structure and item concepts of the PKDD and PKDIA were compared with currently recommended measures, the EORTC QLQ‐C30 and the SF‐36v2®. Results The PKDD is a seven‐item measure of the core signs and symptoms of PK deficiency. The PKDIA is a 14‐item measure of the impacts of PK deficiency on patients’ health‐related quality of life (HRQoL). Minimal similarities were found between the new measures and the EORTC QLQ‐C30 (eg, 43% of concepts were similar to the PKDD; 42% were similar to the PKDIA) and SF‐36v2® (57% of concepts were similar to the PKDD; 17% were similar to the PKDIA). Conclusions The PKDD and PKDIA fill a gap in the existing outcomes measurement strategy for PK deficiency. Future work includes psychometric evaluation of these newly developed measures.
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Affiliation(s)
- Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | | | | | | | | | | | | | - Robert J Klaassen
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Rachael Grace
- Dana-Farber/Boston Children's Cancer and Blood Disorders Program, Boston, MA, USA
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30
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Lauhasurayotin S, Cuvelier GD, Klaassen RJ, Fernandez CV, Pastore YD, Abish S, Rayar M, Steele M, Jardine L, Breakey VR, Brossard J, Sinha R, Silva M, Goodyear L, Lipton JH, Michon B, Corriveau-Bourque C, Sung L, Shabanova I, Li H, Zlateska B, Dhanraj S, Cada M, Scherer SW, Dror Y. Reanalysing genomic data by normalized coverage values uncovers CNVs in bone marrow failure gene panels. NPJ Genom Med 2019; 4:30. [PMID: 31839986 PMCID: PMC6901453 DOI: 10.1038/s41525-019-0104-9] [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] [Received: 10/19/2018] [Accepted: 10/04/2019] [Indexed: 11/09/2022] Open
Abstract
Inherited bone marrow failure syndromes (IBMFSs) are genetically heterogeneous disorders with cytopenia. Many IBMFSs also feature physical malformations and an increased risk of cancer. Point mutations can be identified in about half of patients. Copy number variation (CNVs) have been reported; however, the frequency and spectrum of CNVs are unknown. Unfortunately, current genome-wide methods have major limitations since they may miss small CNVs or may have low sensitivity due to low read depths. Herein, we aimed to determine whether reanalysis of NGS panel data by normalized coverage value could identify CNVs and characterize them. To address this aim, DNA from IBMFS patients was analyzed by a NGS panel assay of known IBMFS genes. After analysis for point mutations, heterozygous and homozygous CNVs were searched by normalized read coverage ratios and specific thresholds. Of the 258 tested patients, 91 were found to have pathogenic point variants. NGS sample data from 165 patients without pathogenic point mutations were re-analyzed for CNVs; 10 patients were found to have deletions. Diamond Blackfan anemia genes most commonly exhibited heterozygous deletions, and included RPS19, RPL11, and RPL5. A diagnosis of GATA2-related disorder was made in a patient with myelodysplastic syndrome who was found to have a heterozygous GATA2 deletion. Importantly, homozygous FANCA deletion were detected in a patient who could not be previously assigned a specific syndromic diagnosis. Lastly, we identified compound heterozygousity for deletions and pathogenic point variants in RBM8A and PARN genes. All deletions were validated by orthogonal methods. We conclude that careful analysis of normalized coverage values can detect CNVs in NGS panels and should be considered as a standard practice prior to do further investigations.
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Affiliation(s)
- Supanun Lauhasurayotin
- 1Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON Canada.,2Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON Canada
| | - Geoff D Cuvelier
- 3Pediatric Hematology-Oncology-Bone Marrow Transplantation, University of Manitoba, Cancer Care Manitoba, Winnipeg, MB Canada
| | - Robert J Klaassen
- 4Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON Canada
| | | | | | - Sharon Abish
- 7Pediatric Hematology Oncology, Montreal Children's Hospital, Montreal, QC Canada
| | - Meera Rayar
- 8Division of Hematology/Oncology, UBC & B.C. Children's Hospital, Vancouver, BC Canada
| | | | - Lawrence Jardine
- 10Children's Hospital, London Health Sciences Centre, London, ON Canada
| | - Vicky R Breakey
- 11Department of Pediatrics, McMaster University, Hamilton, ON Canada
| | - Josee Brossard
- 12Centre hospitalier universitaire, Sherbrooke, QC Canada
| | - Roona Sinha
- 13Royal University Hospital, Saskatoon, SK Canada
| | | | - Lisa Goodyear
- 15Pediatric Hematology/Oncology, Janeway Child Health Centre, St. John's, NF Canada
| | - Jeffrey H Lipton
- 16Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON Canada
| | - Bruno Michon
- 17Centre Hospitalier Universitaire de Quebec, Sainte-Foy, QC Canada
| | | | - Lillian Sung
- 19Population Health Sciences, Research Institute, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON Canada
| | - Iren Shabanova
- 1Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON Canada
| | - Hongbing Li
- 1Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON Canada
| | - Bozana Zlateska
- 1Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON Canada
| | - Santhosh Dhanraj
- 1Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON Canada.,20Institute of Medical Science, University of Toronto, Toronto, ON Canada
| | - Michaela Cada
- 2Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON Canada
| | - Stephen W Scherer
- 1Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON Canada.,21McLaughlin Centre and Department of Molecular Genetics, University of Toronto, Toronto, ON Canada
| | - Yigal Dror
- 1Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON Canada.,2Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON Canada.,20Institute of Medical Science, University of Toronto, Toronto, ON Canada
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31
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Grace RF, Shimano KA, Bhat R, Neunert C, Bussel JB, Klaassen RJ, Lambert MP, Rothman JA, Breakey VR, Hege K, Bennett CM, Rose MJ, Haley KM, Buchanan GR, Geddis A, Lorenzana A, Jeng M, Pastore YD, Crary SE, Neier M, Neufeld EJ, Neu N, Forbes PW, Despotovic JM. Second-line treatments in children with immune thrombocytopenia: Effect on platelet count and patient-centered outcomes. Am J Hematol 2019; 94:741-750. [PMID: 30945320 DOI: 10.1002/ajh.25479] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 04/01/2019] [Indexed: 01/19/2023]
Abstract
Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder with isolated thrombocytopenia and hemorrhagic risk. While many children with ITP can be safely observed, treatments are often needed for various reasons, including to decrease bleeding, or to improve health related quality of life (HRQoL). There are a number of available second-line treatments, including rituximab, thrombopoietin-receptor agonists, oral immunosuppressive agents, and splenectomy, but data comparing treatment outcomes are lacking. ICON1 is a prospective, multi-center, observational study of 120 children starting second-line treatments for ITP designed to compare treatment outcomes including platelet count, bleeding, and HRQoL utilizing the Kids ITP Tool (KIT). While all treatments resulted in increased platelet counts, romiplostim had the most pronounced effect at 6 months (P = .04). Only patients on romiplostim and rituximab had a significant reduction in both skin-related (84% to 48%, P = .01 and 81% to 43%, P = .004) and non-skin-related bleeding symptoms (58% to 14%, P = .0001 and 54% to 17%, P = .0006) after 1 month of treatment. HRQoL significantly improved on all treatments. However, only patients treated with eltrombopag had a median improvement in KIT scores at 1 month that met the minimal important difference (MID). Bleeding, platelet count, and HRQoL improved in each treatment group, but the extent and timing of the effect varied among treatments. These results are hypothesis generating and help to improve our understanding of the effect of each treatment on specific patient outcomes. Combined with future randomized trials, these findings will help clinicians select the optimal second-line treatment for an individual child with ITP.
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Affiliation(s)
- Rachael F. Grace
- Division of Hematology/OncologyDana‐Farber/Boston Children's Cancer and Blood Disorder Center Boston Massachusetts
| | - Kristin A. Shimano
- Division of Pediatric Allergy, Immunology, and Bone Marrow TransplantationUCSF Benioff Children's Hospital San Francisco California
| | - Rukhmi Bhat
- Center for Cancer & Blood Disorders, Ann and Robert H. Lurie Childrens Hospital of ChicagoFeinberg School of Medicine, Northwestern University Chicago Illinois
| | - Cindy Neunert
- Division of Hematology, Oncology, and Stem Cell TransplantColumbia University Medical School New York New York
| | - James B. Bussel
- Department of PediatricsWeill Cornell Medicine New York New York
| | - Robert J. Klaassen
- Division of Hematology/OncologyChildren's Hospital of Eastern Ontario Ottawa Ontario Canada
| | - Michele P. Lambert
- Division of HematologyThe Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Jennifer A. Rothman
- Division of Pediatric Hematology/OncologyDuke University Medical Center Durham North Carolina
| | - Vicky R. Breakey
- Division of Pediatric Hematology/OncologyMcMaster University Hamilton Ontario Canada
| | - Kerry Hege
- Division of Pediatric Hematology/Oncology, Riley Hospital at IU HealthIndiana University School of Medicine Indianapolis Indiana
| | - Carolyn M. Bennett
- Division of Hematology/Oncology, Aflac Cancer and Blood Disorders CenterEmory University School of Medicine, Children's Healthcare of Atlanta Atlanta Georgia
| | - Melissa J. Rose
- Division of Hematology, Oncology, and Bone Marrow Transplant, Nationwide Children's HospitalThe Ohio State University College of Medicine Columbus Ohio
| | - Kristina M. Haley
- Division of Pediatric HematologyOregon Health & Science University Portland Oregon
| | - George R. Buchanan
- Division of Hematology‐OncologyUniversity of Texas Southwestern Medical Center Dallas Texas
| | - Amy Geddis
- Division of Pediatric Hematology/OncologyUniversity of Washington, Seattle Children's Hospital Seattle Washington
| | - Adonis Lorenzana
- Division of Pediatric Hematology/OncologySt. John Ascension Hospital Detroit Michigan
| | - Michael Jeng
- Department of PediatricsStanford School of Medicine Palo Alto California
| | - Yves D. Pastore
- Division of Hematology/OncologyCHU Sainte‐Justine Montreal Québec Canada
| | - Shelley E. Crary
- Department of PediatricsUniversity of Arkansas for Medical Sciences Little Rock Arkansas
| | - Michelle Neier
- Division of Pediatric Hematology/OncologyGoryeb Children's Hospital Morristown New Jersey
| | - Ellis J. Neufeld
- Division of HematologySt. Jude Children's Research Hospital Memphis Tennessee
| | - Nolan Neu
- Division of Hematology/OncologyDana‐Farber/Boston Children's Cancer and Blood Disorder Center Boston Massachusetts
| | - Peter W. Forbes
- Clinical Research CenterBoston Children's Hospital Boston Massachusetts
| | - Jenny M. Despotovic
- Department of PediatricsHematology/Oncology Section, Baylor College of Medicine Houston Texas
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Bui J, Martyres D, James PD, Grabell J, Wu J, Steele M, Silva M, Rand ML, Blanchette VS, Barrowman N, Klaassen RJ. Validation of the school age self-administered pediatric bleeding questionnaire (Self-PBQ) in children aged 8-12 years. Pediatr Blood Cancer 2019; 66:e27709. [PMID: 30900820 PMCID: PMC7643750 DOI: 10.1002/pbc.27709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 02/05/2019] [Accepted: 02/21/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND In the pediatric population, pathologic bleeding is often challenging to identify. The pediatric bleeding questionnaire (PBQ) was developed as a screening tool for von Willebrand disease (VWD) but was designed to be self-completed by children above 12 years of age. The study objective was to determine whether a modified Self-PBQ could be completed by 8- to 12-year-old children with adult assistance. PROCEDURE The initial phase involved seven children who underwent cognitive debriefing to identify problems in the questionnaire, resulting in modifications to wording and response options. In phase 2, children completed the modified Self-PBQ independently or with assistance from their parent at five Canadian treatment centers. Parents filled out the Self-PBQ separately to serve as a comparison. Bleeding scores derived from the child self-report were compared to those of the parent proxy. RESULTS Twenty-nine out of 31 patient/parent pairs successfully completed the Self-PBQ. Child and parent scores demonstrated a high level of agreement with an intraclass correlation (ICC) of 0.825. In the age subgroup analysis, the ICC was 0.834 and 0.824 for the 8- to 9-year-old and 10- to 12-year-old groups, respectively. The ICC was also determined in children with type 1 VWD (ICC = 0.829) versus those with more severe bleeding disorders (ICC = 0.802). Thus, age and disease severity had no significant effect on degree of agreement. CONCLUSIONS Our study shows that agreement was maintained even in younger children aged 8-9 years and in children with varying bleeding phenotypes. This supports the administration of the modified Self-PBQ to 8- to 12-year-old children.
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Affiliation(s)
- Jessica Bui
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Paula D. James
- Department of Medicine, Queen’s University, Kingston, Canada
| | | | - John Wu
- Division of Hematology/Oncology, British Columbia Children’s Hospital, Vancouver, Canada
| | - MacGregor Steele
- Section of Pediatric Hematology, Alberta Children’s Hospital, Calgary, Canada
| | | | - Margaret L. Rand
- Division of Hematology/Oncology and Translational Medicine, The Hospital for Sick Children; Departments of Laboratory Medicine & Pathobiology, Biochemistry, and Pediatrics, University of Toronto, Toronto, Canada
| | - Victor S. Blanchette
- Division of Hematology/Oncology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
| | - Nick Barrowman
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Robert J. Klaassen
- Department of Pediatrics, Division of Hematology/Oncology, Children’s Hospital of Eastern Ontario, Ottawa, Canada
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Anthony SJ, Robertson T, Selkirk E, Dix D, Klaassen RJ, Sung L, Klassen AF. The social impact of early psychological maturity in adolescents with cancer. Psychooncology 2019; 28:586-592. [PMID: 30646430 DOI: 10.1002/pon.4982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/24/2018] [Revised: 12/12/2018] [Accepted: 01/01/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE There is a growing need to assess the long-term quality of life (QOL) of pediatric oncology patients since many children now survive their disease. This paper highlights the subjective perspectives of pediatric cancer patients and specifically explores how experiencing cancer at a young age impacts adolescents in the areas of social functioning, peer relationships, and QOL. The findings emerged from a qualitative research study that explored how pediatric oncology patients ascribe meaning to their illness. METHODS Study participants were recruited from four Canadian academic pediatric hospitals. In this study, we used an interpretative description approach. Semistructured interviews were completed, transcribed verbatim, and coded through the method of constant comparison. RESULTS A total of 37 children and adolescents (n = 19 female; 51%) participated. The majority of participants were diagnosed with leukemia (n = 16; 43%) or lymphoma (n = 9; 24%). Sixty-two percent of participants were adolescents between the ages of 13 and 18 years (n = 23). Data illustrated a unique adolescent experience, which has been reported as a subset of the original population. Adolescent participants noted an accelerated experience of maturation, which invited reflections of gratitude as well as feelings of isolation and disconnect from peers. Participants were saddened to have "missed out" on normative parts of childhood. CONCLUSION Findings highlighted experiences of accelerated maturity that prompted adverse social outcomes for adolescent participants, which impacted their QOL. Future research is needed to explore the intersection of accelerated maturity attributed to illness, social functioning, and QOL. Peer support through technology engagement is suggested for this population.
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Affiliation(s)
- Samantha J Anthony
- Child Health Evaluative Sciences, The Hospital for Sick Children/Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Taylor Robertson
- Child Health Evaluative Sciences, The Hospital for Sick Children/Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
| | - Enid Selkirk
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - David Dix
- Department of Pediatrics Hem/Onc/BMT, BC Children's Hospital, Vancouver, BC, Canada
| | - Robert J Klaassen
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lillian Sung
- Division of Haematology-Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Klaassen RJ. Affairs of the heart, does congenital heart disease make you happier? Arch Dis Child 2019; 104:105. [PMID: 30061201 DOI: 10.1136/archdischild-2018-315401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/17/2018] [Indexed: 11/04/2022]
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Grace RF, Cohen J, Egan S, Wells T, Witherspoon B, Ryan A, Salek SS, Bodie S, Klaassen RJ. The burden of disease in pyruvate kinase deficiency: Patients’ perception of the impact on health-related quality of life. Eur J Haematol 2018; 101:758-765. [DOI: 10.1111/ejh.13128] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/20/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Rachael F. Grace
- Pediatric Hematology/Oncology; Dana-Farber/Boston Children's Cancer and Blood Disorders Center; Boston Massachusetts
| | | | - Shayna Egan
- Endpoint Outcomes; Boston Massachusetts
- Endpoint Outcomes; Long Beach California
| | - Ted Wells
- Endpoint Outcomes; Boston Massachusetts
- Endpoint Outcomes; Long Beach California
| | - Brooke Witherspoon
- Endpoint Outcomes; Boston Massachusetts
- Endpoint Outcomes; Long Beach California
| | - Aisling Ryan
- Endpoint Outcomes; Boston Massachusetts
- Endpoint Outcomes; Long Beach California
| | - Sam S. Salek
- School of Life and Medical Sciences; University of Hertfordshire; Hatfield UK
- Institute for Medicines Development; Cardiff UK
| | - Susan Bodie
- Agios Pharmaceuticals, Inc.; Cambridge Massachusetts
| | - Robert J. Klaassen
- Division of Hematology/Oncology; Children's Hospital of Eastern Ontario; Ottawa ON Canada
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Heeney MM, Guo D, De Falco L, Campagna DR, Olbina G, Kao PPC, Schmitz-Abe K, Rahimov F, Gutschow P, Westerman K, Ostland V, Jackson T, Klaassen RJ, Markianos K, Finberg KE, Iolascon A, Westerman M, London WB, Fleming MD. Normalizing hepcidin predicts TMPRSS6 mutation status in patients with chronic iron deficiency. Blood 2018; 132:448-452. [PMID: 29895660 PMCID: PMC6071554 DOI: 10.1182/blood-2017-03-773028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/06/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Matthew M Heeney
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Dongjing Guo
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Luigia De Falco
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University Medical School, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Dean R Campagna
- Department of Pathology, Boston Children's Hospital, Boston, MA
| | | | - Paige P-C Kao
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | | | - Fedik Rahimov
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Boston, MA
| | | | | | | | - Tracy Jackson
- Division of Pediatric Hematology-Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; and
| | - Robert J Klaassen
- Division of Pediatric Hematology-Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; and
| | | | | | - Achille Iolascon
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University Medical School, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| | | | - Wendy B London
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Mark D Fleming
- Department of Pathology, Boston Children's Hospital, Boston, MA
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Grace RF, Despotovic JM, Bennett CM, Bussel JB, Neier M, Neunert C, Crary SE, Pastore YD, Klaassen RJ, Rothman JA, Hege K, Breakey VR, Rose MJ, Shimano KA, Buchanan GR, Geddis A, Haley KM, Lorenzana A, Thompson A, Jeng M, Neufeld EJ, Brown T, Forbes PW, Lambert MP. Physician decision making in selection of second-line treatments in immune thrombocytopenia in children. Am J Hematol 2018; 93:882-888. [PMID: 29659042 DOI: 10.1002/ajh.25110] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/02/2018] [Accepted: 04/06/2018] [Indexed: 01/19/2023]
Abstract
Immune thrombocytopenia (ITP) is an acquired autoimmune bleeding disorder which presents with isolated thrombocytopenia and risk of hemorrhage. While most children with ITP promptly recover with or without drug therapy, ITP is persistent or chronic in others. When needed, how to select second-line therapies is not clear. ICON1, conducted within the Pediatric ITP Consortium of North America (ICON), is a prospective, observational, longitudinal cohort study of 120 children from 21 centers starting second-line treatments for ITP which examined treatment decisions. Treating physicians reported reasons for selecting therapies, ranking the top three. In a propensity weighted model, the most important factors were patient/parental preference (53%) and treatment-related factors: side effect profile (58%), long-term toxicity (54%), ease of administration (46%), possibility of remission (45%), and perceived efficacy (30%). Physician, health system, and clinical factors rarely influenced decision-making. Patient/parent preferences were selected as reasons more often in chronic ITP (85.7%) than in newly diagnosed (0%) or persistent ITP (14.3%, P = .003). Splenectomy and rituximab were chosen for the possibility of inducing long-term remission (P < .001). Oral agents, such as eltrombopag and immunosuppressants, were chosen for ease of administration and expected adherence (P < .001). Physicians chose rituximab in patients with lower expected adherence (P = .017). Treatment choice showed some physician and treatment center bias. This study illustrates the complexity and many factors involved in decision-making in selecting second-line ITP treatments, given the absence of comparative trials. It highlights shared decision-making and the need for well-conducted, comparative effectiveness studies to allow for informed discussion between patients and clinicians.
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Affiliation(s)
- Rachael F. Grace
- Dana-Farber/Boston Children's Cancer and Blood Disorder Center; Boston Massachusetts
| | - Jenny M. Despotovic
- Texas Children's Hematology Center, Baylor College of Medicine; Houston Texas
| | - Carolyn M. Bennett
- Emory University School of Medicine; Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center; Atlanta Georgia
| | | | | | - Cindy Neunert
- Columbia University Medical School; New York New York
| | - Shelley E. Crary
- University of Arkansas for Medical Sciences; Little Rock Arkansas
| | | | | | | | - Kerry Hege
- Riley Hospital at IU Health, Indiana University School of Medicine; Indianapolis Indiana
| | | | - Melissa J. Rose
- Nationwide Children's Hospital, The Ohio State University College of Medicine; Columbus Ohio
| | | | | | - Amy Geddis
- University of Washington, Seattle Children's Hospital; Seattle Washington
| | | | | | - Alexis Thompson
- Ann and Robert H. Lurie Childrens Hospital of Chicago, Northwestern University, Feinberg School of Medicine; Chicago Illinois
| | - Michael Jeng
- Stanford School of Medicine; Palo Alto California
| | | | - Travis Brown
- Dana-Farber/Boston Children's Cancer and Blood Disorder Center; Boston Massachusetts
| | - Peter W. Forbes
- Boston Children's Hospital, Clinical Research Center; Boston Massachusetts
| | - Michele P. Lambert
- Division of Hematology; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania
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Feldman BM, Rivard GE, Babyn P, Wu JKM, Steele M, Poon MC, Card RT, Israels SJ, Laferriere N, Gill K, Chan AK, Carcao M, Klaassen RJ, Cloutier S, Price VE, Dover S, Blanchette VS. Tailored frequency-escalated primary prophylaxis for severe haemophilia A: results of the 16-year Canadian Hemophilia Prophylaxis Study longitudinal cohort. Lancet Haematol 2018; 5:e252-e260. [PMID: 29731369 DOI: 10.1016/s2352-3026(18)30048-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/24/2018] [Accepted: 03/27/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severe haemophilia A has high morbidity, and treatment, while effective, is very expensive. We report the 16-year follow-up of the Canadian Hemophilia Prophylaxis Study, which examined the effectiveness of tailored frequency-escalated primary prophylaxis with a focus on health outcomes within the domains of body structures and functions, and activities and participation (according to the WHO International Classification of Functioning, Disability and Health [WHO-ICF] framework) and a view to reducing consumption of costly clotting factor, which accounts for more than 90% of the cost of care of severe haemophilia. METHODS In this longitudinal study, boys with severe haemophilia A from 12 Canadian centres were enrolled at age 1·0-2·5 years. They were treated with standard half-life recombinant factor VIII (SHL-rFVIII), beginning as once-weekly prophylaxis with 50 IU/kg and escalating in frequency (with accompanying dose adjustments) in response to breakthrough bleeding as determined by the protocol. The primary endpoint for this analysis was joint health, as measured by the modified Colorado Child Physical Examination Scores (CCPES) at study end. All analyses were done by intention to treat. The trial is complete, and is registered with ClinicalTrials.gov, number NCT01085344. FINDINGS Between June 26, 1997, and Jan 30, 2007, 56 boys were enrolled. They were followed for a median of 10·2 years (to a maximum of 16·1 years). Median rFVIII usage was about 3600 IU/kg per year. The median end-of-study CCPES physical examination score was 1 (IQR 1-3; range 0-12) for the left ankle and 1 (1-2; 0-12) for the right ankle, with all other joints having a median score of 0. No treatment-related safety events occurred over the duration of the study, including central venous catheter infections. The median annualised index joint bleeding rate was 0·95 per year (IQR 0·44-1·35; range 0·00-13·43), but 17 (30%) patients had protocol-defined unacceptable breakthrough bleeding at some point during the study. INTERPRETATION Tailored frequency-escalated prophylaxis leads to very little arthropathy and very good health outcomes within the WHO-ICF domains, and only uses a moderate amount of expensive clotting factor as compared with standard prophylaxis protocols. Some sequelae of bleeding were observed in our cohort, and future studies should consider a more stringent protocol of escalation. FUNDING This study was initially funded by grants from the Medical Research Council of Canada/Pharmaceutical Manufacturers Association of Canada Partnership Fund and the Bayer/Canadian Blood Services/Hema-Quebec Partnership Fund. Subsequent renewals were funded by Bayer.
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Affiliation(s)
- Brian M Feldman
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Georges E Rivard
- Division of Hematology/Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Paul Babyn
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, SK, Canada
| | - John K M Wu
- Division of Hematology/Oncology/BMT, Department of Pediatrics, UBC & BC Children's Hospital, Vancouver, BC, Canada
| | - MacGregor Steele
- Section of Pediatric Hematology, Alberta Children's Hospital, Calgary, AB, Canada
| | - Man-Chiu Poon
- Department of Medicine, Division of Hematology and Hematologic Malignancies, Foothills Hospital, Calgary, AB, Canada
| | - Robert T Card
- Department of Hematology, Division of Oncology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sara J Israels
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Laferriere
- Division of Hematology/Oncology, Thunder Bay Regional Cancer Care, Thunder Bay, ON, Canada
| | - Kulwant Gill
- Hemophilia Program, Laurentian Hospital, Sudbury, ON, Canada
| | - Anthony K Chan
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Manuel Carcao
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert J Klaassen
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Stephanie Cloutier
- Centre de l'hémophilie de l'est du Québec de Québec-Hôpital de l'Enfant-Jésus, Université Laval, Quebec, QC, Canada
| | - Victoria E Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Saunya Dover
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Victor S Blanchette
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Arbiv OA, Cuvelier G, Klaassen RJ, Fernandez CV, Robitaille N, Steele M, Breakey V, Abish S, Wu J, Sinha R, Silva M, Goodyear L, Jardine L, Lipton JH, Corriveau-Bourque C, Brossard J, Michon B, Ghemlas I, Waespe N, Zlateska B, Sung L, Cada M, Dror Y. Molecular analysis and genotype-phenotype correlation of Diamond-Blackfan anemia. Clin Genet 2017; 93:320-328. [PMID: 29044489 DOI: 10.1111/cge.13158] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 08/11/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 02/03/2023]
Abstract
Diamond-Blackfan anemia (DBA) features hypoplastic anemia and congenital malformations, largely caused by mutations in various ribosomal proteins. The aim of this study was to characterize the spectrum of genetic lesions causing DBA and identify genotypes that correlate with phenotypes of clinical significance. Seventy-four patients with DBA from across Canada were included. Nucleotide-level mutations or large deletions were identified in 10 ribosomal genes in 45 cases. The RPS19 mutation group was associated with higher requirement for chronic treatment for anemia than other DBA groups. Patients with RPS19 mutations, however, were more likely to maintain long-term corticosteroid response without requirement for further chronic transfusions. Conversely, patients with RPL11 mutations were less likely to need chronic treatment. Birth defects, including cardiac, skeletal, hand, cleft lip or palate and genitourinary malformations, also varied among the various genetic groups. Patients with RPS19 mutations had the fewest number of defects, while patients with RPL5 had the greatest number of birth defects. This is the first study to show differences between DBA genetic groups with regards to treatment. Previously unreported differences in the rate and types of birth defects were also identified. These data allow better patient counseling, a more personalized monitoring plan, and may also suggest differential functions of DBA genes on ribosome and extra-ribosomal functions.
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Affiliation(s)
- O A Arbiv
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - G Cuvelier
- Division of Haematology/Oncology, CancerCare Manitoba, Winnipeg, Canada
| | - R J Klaassen
- Division of Haematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - C V Fernandez
- Division of Haematology/Oncology, IWK Health Centre, Halifax, Canada
| | - N Robitaille
- Division of Haematology/Oncology, CHU Sainte Justine, Montreal, Canada
| | - M Steele
- Division of Haematology/Oncology, Alberta Children's Hospital, Calgary, Canada
| | - V Breakey
- Division of Haematology/Oncology, McMaster Children's Hospital, Hamilton, Canada
| | - S Abish
- Division of Haematology/Oncology, Montreal Children's Hospital, Montreal, Canada
| | - J Wu
- Division of Haematology/Oncology, British Columbia Children's Hospital, Vancouver, Canada
| | - R Sinha
- Division of Haematology/Oncology, University of Saskatchewan, Saskatoon, Canada
| | - M Silva
- Division of Haematology/Oncology, Queen's University, Kingston, Canada
| | - L Goodyear
- Division of Haematology/Oncology, Janeway Child Health Centre, St. John's, Canada
| | - L Jardine
- Division of Haematology/Oncology, Children's Hospital of Western Ontario, London, Canada
| | - J H Lipton
- Department of Haematology and Internal Medicine, Princess Margaret Hospital, Toronto, Canada
| | - C Corriveau-Bourque
- Division of Haematology/Oncology, University of Alberta Health Sciences Centre, Edmonton, Canada
| | - J Brossard
- Division of Haematology/Oncology, Centre Y Sante L'Estrie-Fleur, Sherbrooke, Canada
| | - B Michon
- Division of Haematology/Oncology, Centre Hospitalier de l'Université Laval, Quebec City, Canada
| | - I Ghemlas
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.,Division of Haematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - N Waespe
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.,The Marrow Failure and Myelodysplasia Program, Haematology Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - B Zlateska
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.,The Marrow Failure and Myelodysplasia Program, Haematology Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - L Sung
- Program in Child Health and Evaluative Medicine, Research Institute, The Hospital for Sick Children, Toronto, Canada.,Lymphoma Leukemia Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - M Cada
- The Marrow Failure and Myelodysplasia Program, Haematology Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Y Dror
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.,The Marrow Failure and Myelodysplasia Program, Haematology Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Canada
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Casey LJ, Klaassen RJ, Rand ML, James PD. Reply to comment on: Generation and optimization of the self-administered pediatric bleeding questionnaire and its validation as a screening tool for von Willebrand disease. Pediatr Blood Cancer 2017; 64. [PMID: 28792666 DOI: 10.1002/pbc.26763] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Lara J Casey
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Robert J Klaassen
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Margaret L Rand
- Division of Hematology/Oncology and Program in Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine & Pathobiology, Biochemistry and Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Paula D James
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Rashidian H, Liu YMC, Geraghty MT, Kobayashi J, Donner EJ, Klaassen RJ. Severe Neutropenia and Anemia in a Child With Epilepsy and Copper Deficiency on a Ketogenic Diet. Pediatr Neurol 2017; 76:93-94. [PMID: 28958403 DOI: 10.1016/j.pediatrneurol.2017.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 08/11/2017] [Accepted: 08/16/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Houman Rashidian
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada
| | - Y M Christiana Liu
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada
| | | | - Jeff Kobayashi
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada
| | - Elizabeth J Donner
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada
| | - Robert J Klaassen
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Canada.
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Casey LJ, Tuttle A, Grabell J, Hopman W, Moorehead PC, Blanchette VS, Wu JK, Steele M, Klaassen RJ, Silva M, Rand ML, James PD. Generation and optimization of the self-administered pediatric bleeding questionnaire and its validation as a screening tool for von Willebrand disease. Pediatr Blood Cancer 2017; 64. [PMID: 28453185 DOI: 10.1002/pbc.26588] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 03/05/2017] [Accepted: 03/06/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Our objective was to generate, optimize, and validate a self-administered pediatric bleeding questionnaire (Self-PBQ) as a screening tool for von Willebrand disease (VWD) in children referred to the hematology clinic for the first time. STUDY DESIGN The Self-PBQ was generated by combining the validated expert-administered PBQ and the International Society on Thrombosis and Hemostasis (ISTH) bleeding assessment tool (BAT). Medical terminology was translated into lay language requiring a grade 4 reading level. In Phase 1, the Self-PBQ was optimized and the level of agreement between the Self-PBQ and the expert-administered PBQ was determined. Phase 2 established the normal range of bleeding scores (BSs) of the Self-PBQ. Phase 3 examined the Self-PBQ as a screening tool for first-time referrals to the hematology clinic. RESULTS The Self-PBQ is a reliable surrogate for the expert-administered PBQ with an excellent intraclass correlation (ICC) of 0.917. The Self-PBQ was scored with the PBQ and the ISTH-BAT scoring systems, for which its normal BS ranges are -1 to 2 or 0 to 2, respectively. A positive Self-PBQ BS (≥3) had a sensitivity of 78%, a specificity of 37%, a positive predictive value of 0.18, and a negative predictive value of 0.91 for identifying VWD in children being investigated by a hematologist for a bleeding disorder. CONCLUSION The Self-PBQ generates comparable BSs to the expert-administered PBQ and is a reliable, reasonably sensitive screening tool to incorporate into the assessment of children presenting to a hematologist for the investigation of an inherited bleeding disorder.
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Affiliation(s)
| | | | | | | | - Paul C Moorehead
- Janeway Children's Health and Rehabilitation Centre, St. John's, Canada.,Discipline of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Canada
| | - Victor S Blanchette
- Division of Hematology/Oncology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
| | - John K Wu
- British Columbia Children's Hospital, Vancouver, Canada
| | | | | | | | - Margaret L Rand
- Division of Hematology/Oncology and Program in Experimental Medicine, The Hospital for Sick Children.,Departments of Laboratory Medicine & Pathobiology, Biochemistry and Pediatrics, University of Toronto, Toronto, Canada
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Flores A, Klaassen RJ, Buchanan GR, Neunert CE. Patterns and influences in health-related quality of life in children with immune thrombocytopenia: A study from the Dallas ITP Cohort. Pediatr Blood Cancer 2017; 64. [PMID: 28111877 DOI: 10.1002/pbc.26405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/15/2016] [Accepted: 11/17/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Relationships between clinical/demographic factors and health-related quality of life (HRQoL) in childhood immune thrombocytopenia (ITP) remain poorly understood. Recent studies reveal conflicting information about factors that contribute to HRQoL. METHODS This was a prospective, single-institution, cohort study of newly diagnosed children with ITP. Serial evaluations of HRQoL were performed using the Kid's ITP Tools (KIT), scored from 0 (worst) to 100 (best), at enrollment and 1 week, 6 months, and 12 months following diagnosis. All visits included bleeding severity grading. Relationships between HRQoL and platelet count, treatment, bleeding severity, and course of disease were examined. RESULTS A total of 99 children with newly diagnosed ITP were evaluable for analysis. KIT scores were low at diagnosis for parents (median 26, range 15-43) and children (median 65, range 55-81) and were not influenced by age or platelet count. At diagnosis, children who received treatment had lower platelet counts (P = 0.005), more severe hemorrhage (P < 0.0125), and lower HRQoL by parent, child, and proxy reporting (P < 0.05). Oral bleeding negatively impacted proxy-reported disease burden at diagnosis (P = 0.01). Persistence of disease and lower platelet counts at 6 and 12 month visits were the only factors noted to consistently impact quality of life beyond diagnosis for both parents and children. CONCLUSIONS HRQoL is low at diagnosis but significantly improves over time. Patients with ongoing disease and lower platelet counts continue to have significant disease burden.
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Affiliation(s)
- Adolfo Flores
- Department of Pediatrics, Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert J Klaassen
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - George R Buchanan
- Department of Pediatrics, Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Cindy E Neunert
- Department of Pediatrics, Columbia University, New York, New York
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44
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Waespe N, Dhanraj S, Wahala M, Tsangaris E, Enbar T, Zlateska B, Li H, Klaassen RJ, Fernandez CV, Cuvelier GDE, Wu JK, Pastore YD, Silva M, Lipton JH, Brossard J, Michon B, Abish S, Steele M, Sinha R, Belletrutti MJ, Breakey VR, Jardine L, Goodyear L, Kofler L, Cada M, Sung L, Shago M, Scherer SW, Dror Y. The clinical impact of copy number variants in inherited bone marrow failure syndromes. NPJ Genom Med 2017; 2. [PMID: 28690869 PMCID: PMC5498150 DOI: 10.1038/s41525-017-0019-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 12/18/2022] Open
Abstract
Inherited bone marrow failure syndromes comprise a genetically heterogeneous group of diseases with hematopoietic failure and a wide array of physical malformations. Copy number variants were reported in some inherited bone marrow failure syndromes. It is unclear what impact copy number variants play in patients evaluated for a suspected diagnosis of inherited bone marrow failure syndromes. Clinical and genetic data of 323 patients from the Canadian Inherited Marrow Failure Registry from 2001 to 2014, who had a documented genetic work-up, were analyzed. Cases with pathogenic copy number variants (at least 1 kilobasepairs) were compared to cases with other mutations. Genotype-phenotype correlations were performed to assess the impact of copy number variants. Pathogenic nucleotide-level mutations were found in 157 of 303 tested patients (51.8%). Genome-wide copy number variant analysis by single-nucleotide polymorphism arrays or comparative genomic hybridization arrays revealed pathogenic copy number variants in 11 of 67 patients tested (16.4%). In four of these patients, identification of copy number variant was crucial for establishing the correct diagnosis as their clinical presentation was ambiguous. Eight additional patients were identified to harbor pathogenic copy number variants by other methods. Of the 19 patients with pathogenic copy number variants, four had compound-heterozygosity of a copy number variant with a nucleotide-level mutation. Pathogenic copy number variants were associated with more extensive non-hematological organ system involvement (p = 0.0006), developmental delay (p = 0.006) and short stature (p = 0.04) compared to nucleotide-level mutations. In conclusion, a significant proportion of patients with inherited bone marrow failure syndromes harbor pathogenic copy number variants which were associated with a more extensive non-hematological phenotype in this cohort. Patients with a phenotype suggestive of inherited bone marrow failure syndromes but without identification of pathogenic nucleotide-level mutations should undergo specific testing for copy number variants. Copy number variation in patients with inherited bone marrow failure syndromes (IBMFSs) is associated with more severe clinical symptoms. In addition to persistently low levels of red blood cells, white blood cells and/ or platelets, patients with IBMFSs also present varying degrees of physical malformations. Most cases are associated with single base-pair mutations in the DNA sequence, but Canadian researchers led by Yigal Dror at The Hospital for Sick Children in Toronto, have found that whole sections of the genome are deleted or repeated in an important proportion of patients. Those carrying copy number variants (CNV) presented more commonly with developmental delay, short stature and defects in more organ systems, than patients with point mutations. CNV analysis of patients with suspected IBMFSs could aid early disease evaluation and management.
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Affiliation(s)
- Nicolas Waespe
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada.,Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Santhosh Dhanraj
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Manju Wahala
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elena Tsangaris
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tom Enbar
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bozana Zlateska
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Hongbing Li
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robert J Klaassen
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - Geoff D E Cuvelier
- Pediatric Hematology/Oncology, University of Manitoba, CancerCare Manitoba, Winnipeg, MB, Canada
| | - John K Wu
- Division of Hematology/Oncology, UBC & B.C. Children's Hospital, Vancouver, BC, Canada
| | | | | | - Jeffrey H Lipton
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Joseé Brossard
- Centre Hospitalier Universitaire, Sherbrooke, QC, Canada
| | - Bruno Michon
- Centre Hospitalier Universitaire, Québec, QC, Canada
| | - Sharon Abish
- Pediatric Hematology Oncology, Montreal Children's Hospital, Montreal, QC, Canada
| | | | - Roona Sinha
- Royal University Hospital, Saskatoon, SK, Canada
| | | | - Vicky R Breakey
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Lawrence Jardine
- Children's Hospital, London Health Sciences Centre, London, ON, Canada
| | - Lisa Goodyear
- Pediatric Hematology/Oncology, Janeway Child Health Centre, St. John's, NF, Canada
| | - Liat Kofler
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michaela Cada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Lillian Sung
- Population Health Sciences, Research Institute, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mary Shago
- Cytogenetics Laboratory, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Stephen W Scherer
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Yigal Dror
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada.,Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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45
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Haverman L, Limperg PF, Young NL, Grootenhuis MA, Klaassen RJ. Paediatric health-related quality of life: what is it and why should we measure it? Arch Dis Child 2017; 102:393-400. [PMID: 27831905 DOI: 10.1136/archdischild-2015-310068] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/08/2016] [Accepted: 09/10/2016] [Indexed: 01/19/2023]
Affiliation(s)
- L Haverman
- Psychosocial Department G8-136, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - P F Limperg
- Psychosocial Department G8-136, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - N L Young
- School of Rural and Northern Health, Laurentian University, Sudbury, Ontario, Canada
| | - M A Grootenhuis
- Psychosocial Department G8-136, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - R J Klaassen
- Division of Hematology/Oncology, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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46
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Martyres DJ, Vijenthira A, Barrowman N, Harris-Janz S, Chretien C, Klaassen RJ. Reply to: Vitamin insufficiencies/deficiencies in relation to sickle cell disease severity and associated morbidity. Pediatr Blood Cancer 2016; 63:2250-2251. [PMID: 27392202 DOI: 10.1002/pbc.26130] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 11/08/2022]
Affiliation(s)
| | - Abi Vijenthira
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Nick Barrowman
- Clinical Research Unit, The Children's Hospital of Eastern Ontario, Ontario, Canada
| | - Sydney Harris-Janz
- Division of Hematology/Oncology, The Children's Hospital of Eastern Ontario, Ontario, Canada
| | - Christine Chretien
- Division of Hematology/Oncology, The Children's Hospital of Eastern Ontario, Ontario, Canada
| | - Robert J Klaassen
- Division of Hematology/Oncology, The Children's Hospital of Eastern Ontario, Ontario, Canada.
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47
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Waespe N, Van Den Akker M, Klaassen RJ, Lieberman L, Irwin MS, Ali SS, Abdelhaleem M, Zlateska B, Liebman M, Cada M, Schechter T, Dror Y. Response to treatment with azacitidine in children with advanced myelodysplastic syndrome prior to hematopoietic stem cell transplantation. Haematologica 2016; 101:1508-1515. [PMID: 27540140 DOI: 10.3324/haematol.2016.145821] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/18/2016] [Indexed: 12/14/2022] Open
Abstract
Advanced myelodysplastic syndrome harbors a high risk of progression to acute myeloid leukemia and poor prognosis. In children, there is no established treatment to prevent or delay progression to leukemia prior to hematopoietic stem cell transplantation. Azacitidine is a hypomethylating agent, which was shown to slow progression to leukemia in adults with myelodysplastic syndrome. There is little data on the efficacy of azacitidine in children. We reviewed 22 pediatric patients with advanced myelodysplastic syndrome from a single center, diagnosed between January 2000 and December 2015. Of those, eight patients received off-label azacitidine before hematopoietic stem cell transplantation. A total of 31 cycles were administered and modification or delay occurred in four of them due to cytopenias, infection, nausea/vomiting, and transient renal impairment. Bone marrow blast percentages in azacitidine-treated patients decreased significantly from a median of 15% (range 9-31%) at the start of treatment to 5.5% (0-12%, P=0.02) before hematopoietic stem cell transplantation. Following azacitidine treatment, four patients (50%) achieved marrow remission, and none progressed. In contrast, three untreated patients (21.4%) had progressive disease characterized by >50% increase in blast counts or progression to leukemia. Azacitidine-treated patients had significantly increased 4-year event-free survival (P=0.04); predicted 4-year overall survival was 100% versus 69.3% in untreated patients (P=0.1). In summary, azacitidine treatment prior to hematopoietic stem cell transplantation was well tolerated in pediatric patients with advanced myelodysplastic syndrome, led to partial or complete bone marrow response in seven of eight patients (87.5%), and correlated with superior event-free survival in this cohort.
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Affiliation(s)
- Nicolas Waespe
- Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada.,Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
| | - Machiel Van Den Akker
- Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada.,Pediatric Hematology/Oncology, UZ Brussel, Jette, Belgium
| | - Robert J Klaassen
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Lani Lieberman
- Department of Laboratory Medicine, University Health Network, Toronto, Canada
| | - Meredith S Irwin
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Salah S Ali
- Bone Marrow Transplantation Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Mohamed Abdelhaleem
- Department of Pediatric Laboratory Medicine, Division of Hematopathology, The Hospital for Sick Children, Toronto, Canada
| | - Bozana Zlateska
- Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada.,Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
| | - Mira Liebman
- Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Michaela Cada
- Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Tal Schechter
- Bone Marrow Transplantation Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Yigal Dror
- Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada .,Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada.,Institute of Medical Science, University of Toronto, Canada
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48
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Martyres DJ, Vijenthira A, Barrowman N, Harris-Janz S, Chretien C, Klaassen RJ. Nutrient Insufficiencies/Deficiencies in Children With Sickle Cell Disease and Its Association With Increased Disease Severity. Pediatr Blood Cancer 2016; 63:1060-4. [PMID: 26855061 DOI: 10.1002/pbc.25940] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 01/11/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is characteristically described as a disease of hemolytic anemia and vaso-occlusive crises (VOCs). However, patients suffer from a multitude of other problems including impaired development, chronic pain, and increased susceptibility to infection. Nutritional deficiency has been implicated as a contributor to these issues. PROCEDURE We reported the nutrition status with respect to vitamin D, zinc, B6, B12, folate, and homocysteine serum levels in Canadian children with SCD (n = 91). We also tested for associations between nutrients and markers of disease severity and growth. RESULTS Almost half the sample (42%) had multiple nutrient insufficiencies/deficiencies, and a further 27% had a single insufficiency/deficiency. The most common insufficiency/deficiency was zinc in 57% followed by calcidiol (25 dihydroxyvitamin D (25(OH)D)) (52%). Sixteen percent of patients had low vitamin B6 levels, while folate, calcitriol (1,25(OH)D), and homocysteine levels were normal. Increased number of vitamin insufficiencies/deficiencies was associated with increasing disease severity (P = 0.018). Zinc insufficiency/deficiency was significantly associated with an increased number of home pain crises (P = 0.001) and an increased incidence of hospitalizations for VOCs (P = 0.01). CONCLUSIONS Our findings show that patients with SCD commonly have multiple nutrient insufficiencies/deficiencies and support the growing evidence for the link between low zinc and increased VOC. It also indicates that increased nutrient insufficiencies/deficiencies are associated with increased disease severity in SCD. Prospective studies with larger samples are needed to further elucidate the relationship between nutrient deficiencies and SCD, and to determine whether nutrient supplementation can improve the disease course.
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Affiliation(s)
- David J Martyres
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Abi Vijenthira
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nick Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sydney Harris-Janz
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Christine Chretien
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Robert J Klaassen
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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49
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St-Louis J, Urajnik DJ, Ménard F, Cloutier S, Klaassen RJ, Ritchie B, Rivard GE, Warner M, Blanchette V, Young NL. Generic and disease-specific quality of life among youth and young men with Hemophilia in Canada. BMC Hematol 2016; 16:13. [PMID: 27158500 PMCID: PMC4858890 DOI: 10.1186/s12878-016-0052-x] [Citation(s) in RCA: 18] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/27/2016] [Indexed: 11/20/2022]
Abstract
Background This study was undertaken to explore the longitudinal patterns of health-related quality of life (HRQoL) among youth and young adults with Hemophilia A (HA) over a 3-year period. This report presents the baseline characteristics of the study cohort. Methods Males, 14 to 29 years of age, with predominantly severe HA were recruited from six treatment centres in Canada. Subjects completed a comprehensive survey. HRQoL was measured using: the CHO-KLAT2.0 (youth), Haemo-QoL-A (young adults) and the SF-36v2 (all). Results 13 youth (mean age = 15.7, range = 12.9-17.9 years) and 33 young adults (mean age = 23.6; range = 18.4 -28.7 years) with moderate (7 %) and severe (93 %) HA were enrolled. All were on a prophylactic regimen with antihemophilic factor (Helixate FS®) during the study. The youth had minimal joint damage (mean HJHS = 5.2) compared to young adults (mean HJHS = 13.3). The mean HRQoL scores for youth were: 79.2 (SD = 11.9) for the CHO-KLAT, and 53.0 (5.5) and 52.3 (6.8) for the SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores respectively. The mean HRQoL scores for young adults were: 85.8 (9.5) for the Haemo-Qol-A, and 50.8 (6.4) and 50.9 (8.8) for PCS and MCS respectively. PCS and MCS scores were comparable to published Canadian norms, however significant differences were found for the domains of Physical Functioning and Bodily Pain. The disease-specific HRQoL scores were weakly correlated with the PCS for youth (CHO-KLAT vs. PCS r = 0.28, p = 0.35); and moderately correlated for the MCS (r = 0.39, p = 0.19). Haemo-QoL-A scores for young adults were strongly correlated with the PCS (r = 0.53, p = 0.001); and weakly correlated with the MCS (r = 0.26, p = 0.13). Joint status as assessed by HJHS was correlated with PCS scores. A history of lifelong prophylaxis resulted in better PCS but worse MCS scores. Conclusion Despite having hemophilia, the youth in this cohort have minimal joint disease and good HRQoL. The young adults demonstrated more joint disease and slightly worse HRQoL in the domains of physical functioning and pain. The data presented here provide new information to inform the selection of Health Related Quality of Life (HRQoL) instruments for use in future clinical trials involving persons with hemophilia. Trial registration ClinicalTrials.gov : NCT01034904. Study funded by CSL Behring Canada. Electronic supplementary material The online version of this article (doi:10.1186/s12878-016-0052-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J St-Louis
- CHU Sainte-Justine, Montréal, Canada ; Hôpital Maisonneuve-Rosemont, Montreal, Canada
| | | | - F Ménard
- CHU Sainte-Justine, Montréal, Canada
| | - S Cloutier
- Hôpital de l'Enfant-Jésus, Quebec city, Canada
| | - R J Klaassen
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - B Ritchie
- University of Alberta, Edmonton, Canada
| | | | - M Warner
- McGill University Health Centre, Montréal, Canada
| | - V Blanchette
- University of Toronto, Toronto, Canada ; Hospital for Sick Children, Toronto, Canada
| | - N L Young
- Laurentian University, Sudbury, Canada ; Hospital for Sick Children, Toronto, Canada
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50
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Cardona I, Ferretti E, Daboval T, Klaassen RJ, Dror Y. Case 1: A newborn with pancytopenia. Paediatr Child Health 2016; 21:9-11. [PMID: 26941551 DOI: 10.1093/pch/21.1.9] [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: 11/13/2022] Open
Affiliation(s)
- Isabel Cardona
- Department of Otolaryngology Pediatrics - Head & Neck Surgery, McGill University Health Centre, Montreal Children's Hospital, Montreal, Quebec
| | | | | | - Robert J Klaassen
- Department of Pediatrics, Division of Oncology and Hematology, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Yigal Dror
- Department of Pediatrics, Division of Hematology Oncology, Marrow Failure and Myelodysplasia Program, The Hospital for Sick Children, Toronto, Ontario
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