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Ludwig LS, Lareau CA, Bao EL, Liu N, Utsugisawa T, Tseng AM, Myers SA, Verboon JM, Ulirsch JC, Luo W, Muus C, Fiorini C, Olive ME, Vockley CM, Munschauer M, Hunter A, Ogura H, Yamamoto T, Inada H, Nakagawa S, Ohzono S, Subramanian V, Chiarle R, Glader B, Carr SA, Aryee MJ, Kundaje A, Orkin SH, Regev A, McCavit TL, Kanno H, Sankaran VG. Congenital anemia reveals distinct targeting mechanisms for master transcription factor GATA1. Blood 2022; 139:2534-2546. [PMID: 35030251 PMCID: PMC9029090 DOI: 10.1182/blood.2021013753] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/24/2021] [Indexed: 11/20/2022] Open
Abstract
Master regulators, such as the hematopoietic transcription factor (TF) GATA1, play an essential role in orchestrating lineage commitment and differentiation. However, the precise mechanisms by which such TFs regulate transcription through interactions with specific cis-regulatory elements remain incompletely understood. Here, we describe a form of congenital hemolytic anemia caused by missense mutations in an intrinsically disordered region of GATA1, with a poorly understood role in transcriptional regulation. Through integrative functional approaches, we demonstrate that these mutations perturb GATA1 transcriptional activity by partially impairing nuclear localization and selectively altering precise chromatin occupancy by GATA1. These alterations in chromatin occupancy and concordant chromatin accessibility changes alter faithful gene expression, with failure to both effectively silence and activate select genes necessary for effective terminal red cell production. We demonstrate how disease-causing mutations can reveal regulatory mechanisms that enable the faithful genomic targeting of master TFs during cellular differentiation.
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Affiliation(s)
- Leif S Ludwig
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin Institute for Medical Systems Biology, Berlin, Germany
| | - Caleb A Lareau
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
- Department of Computer Science and
- Department of Genetics, Stanford University, Stanford, CA
| | - Erik L Bao
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
- Harvard-MIT Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Nan Liu
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Bone Marrow Transplantation Center of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
| | - Taiju Utsugisawa
- Department of Transfusion Medicine and Cell Processing, Faculty of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Alex M Tseng
- Department of Computer Science and
- Department of Genetics, Stanford University, Stanford, CA
| | - Samuel A Myers
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
- La Jolla Institute for Immunology, La Jolla, CA
| | - Jeffrey M Verboon
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
| | - Jacob C Ulirsch
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
- Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA
| | - Wendy Luo
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
| | - Christoph Muus
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
- John A. Paulson School of Engineering and Applied Sciences, Faculty of Arts and Sciences, Harvard University, Cambridge, MA
| | - Claudia Fiorini
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
| | - Meagan E Olive
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
| | - Christopher M Vockley
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
| | - Mathias Munschauer
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
- Helmholtz Institute for RNA-Based Infection Research, Helmholtz Center for Infection Research, Würzburg, Germany
- Infection and Immunity Department, Faculty of Medicine, University of Würzburg, Würzburg, Germany
| | | | - Hiromi Ogura
- Department of Transfusion Medicine and Cell Processing, Faculty of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshiyuki Yamamoto
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Shinichiro Nakagawa
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Shuichi Ohzono
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Vidya Subramanian
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
| | - Roberto Chiarle
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Bertil Glader
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Steven A Carr
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
| | - Martin J Aryee
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
- Molecular Pathology Unit, Massachusetts General Hospital, Charlestown, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Anshul Kundaje
- Department of Computer Science and
- Department of Genetics, Stanford University, Stanford, CA
| | - Stuart H Orkin
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Howard Hughes Medical Institute, Chevy Chase, MD
| | - Aviv Regev
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
- Howard Hughes Medical Institute, Chevy Chase, MD
- Department of Biology and
- Koch Institute of Integrative Cancer Research, MIT, Cambridge, MA; and
| | | | - Hitoshi Kanno
- Department of Transfusion Medicine and Cell Processing, Faculty of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Vijay G Sankaran
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA
- Harvard Stem Cell Institute, Cambridge, MA
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Luu HS, McCavit TL, Park JY, Mitui M, Lopez DD, Timmons CF. Hb Alcorn County: A β-Globin Variant [β40(C6)Arg→Thr; HBB: c.122G>C (p.Arg41Thr)] with Increased Oxygen Affinity. Hemoglobin 2019; 43:204-206. [PMID: 31397596 DOI: 10.1080/03630269.2019.1649279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We describe Hb Alcorn County, a heterozygous hemoglobin (Hb) variant, in a 6-month-old Hispanic male and his mother. DNA sequencing demonstrated a mutation on the HBB gene [β40(C6)Arg→Thr; HBB: c.122G>C (p.Arg41Thr)], predictive of a substitution of arginine to threonine at position 40 of the β-globin protein. This amino acid substitution involves the α1β2 contact and occurs at the same position as Hb Austin [β40(C6)Arg→Ser; HBB: c.[123G>C or 123G>T] (p.Arg41Ser)] and Hb Athens-GA [β40(C6)Arg→Lys; HBB: c.122G>A (p.Arg41Lys)], both of which show increased oxygen affinity.
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Affiliation(s)
- Hung S Luu
- Department of Pathology, University of Texas Southwestern Medical Center , Dallas , TX , USA.,Department of Pathology, Children's Health , Dallas , TX , USA
| | - Timothy L McCavit
- Hematology and Oncology Center, Cook Children's Health Care System , Fort Worth , TX , USA
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center , Dallas , TX , USA.,Department of Pathology, Children's Health , Dallas , TX , USA.,Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Midori Mitui
- Department of Pathology, Children's Health , Dallas , TX , USA
| | - Dania D Lopez
- Department of Pathology, Children's Health , Dallas , TX , USA
| | - Charles F Timmons
- Department of Pathology, University of Texas Southwestern Medical Center , Dallas , TX , USA.,Department of Pathology, Children's Health , Dallas , TX , USA
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3
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Jordan LC, Roberts Williams DO, Rodeghier MJ, Covert Greene BV, Ponisio MR, Casella JF, McKinstry RC, Noetzel MJ, Kirkham FJ, Meier ER, Fuh B, McNaull M, Sarnaik S, Majumdar S, McCavit TL, DeBaun MR. Children with sickle cell anemia with normal transcranial Doppler ultrasounds and without silent infarcts have a low incidence of new strokes. Am J Hematol 2018. [PMID: 29520844 DOI: 10.1002/ajh.25085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In a prospective cohort study, we tested the hypothesis that children with sickle cell anemia (SCA) with normal transcranial Doppler ultrasound (TCD) velocities and without silent cerebral infarcts (SCIs) would have a lower incidence rate of new neurological events (strokes, seizures or transient ischemic attacks) compared to children with normal TCD measurements and SCIs, not receiving regular blood transfusions. Nonrandomized participants from the silent cerebral infarct transfusion (SIT) Trial who had screening magnetic resonance imaging (MRI) of the brain and normal TCD measurements were included. Follow-up ended at the time of first neurological event (stroke, seizure or transient ischemic attack), start of regular blood transfusion, or loss to follow-up, whichever came first. The primary endpoint was a new neurological event. Of 421 participants included, 68 had suspected SCIs. Mean follow-up was 3.6 years. Incidence rates of new neurological events in nontransfused participants with normal TCD values with SCIs and without SCIs were 1.71 and 0.47 neurological events per 100 patient-years, respectively, P = .065. The absence of SCI(s) at baseline was associated with a decreased risk of a new neurological event (hazard ratio 0.231, 95% CI 0.062-0.858; P = .029). Local pediatric neurologists examined 67 of 68 participants with suspected SCIs and identified 2 with overt strokes classified as SCIs by local hematologists; subsequently one had a seizure and the other an ischemic stroke. Children with SCA, without SCIs, and normal TCD measurements have a significantly lower rate of new neurological events when compared to those with SCIs and normal TCD measurements. Pediatric neurology assessment may assist risk stratification.
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Affiliation(s)
- Lori C. Jordan
- Department of Pediatrics, Division of Pediatric NeurologyVanderbilt University Medical CenterNashville Tennessee
| | - Dionna O. Roberts Williams
- Department of Pediatrics, Division of Hematology/OncologyVanderbilt‐Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical CenterNashville Tennessee
| | | | - Brittany V. Covert Greene
- Department of Pediatrics, Division of Hematology/OncologyVanderbilt‐Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical CenterNashville Tennessee
| | - Maria R. Ponisio
- Department of RadiologyWashington University School of MedicineSt. Louis Missouri
| | - James F. Casella
- Department of Pediatrics, Division of Hematologythe Johns Hopkins University School of MedicineBaltimore Maryland
| | - Robert C. McKinstry
- Departments of Radiology and PediatricsWashington University School of MedicineSt. Louis Missouri
| | - Michael J. Noetzel
- Departments of Neurology and PediatricsWashington University School of MedicineSt Louis Missouri
| | - Fenella J. Kirkham
- Developmental NeurosciencesUniversity College London Great Ormond Street Institute of Child HealthLondon United Kingdom
| | - Emily R. Meier
- Indiana Hemophilia & Thrombosis CenterIndianapolis Indiana
| | - Beng Fuh
- Department of PediatricsHematology/Oncology, Brody School of Medicine at East Carolina UniversityGreenville North Carolina
| | - Melissa McNaull
- Department of PediatricsHematology/Oncology, University of Mississippi Medical CenterJackson Mississippi
| | - Sharada Sarnaik
- Department of Pediatrics, Division of Hematology/OncologyWayne State UniversityDetroit Michigan
| | - Suvankar Majumdar
- Center for Cancer and Blood Disorders, Children's National Medical CenterWashington DC
| | - Timothy L. McCavit
- Department of Pediatrics, Division of Hematology/OncologyCook Children's HospitalFort Worth Texas
| | - Michael R. DeBaun
- Department of Pediatrics, Division of Hematology/OncologyVanderbilt‐Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical CenterNashville Tennessee
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Affiliation(s)
- Jacquelyn M Powers
- Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas
| | - George R Buchanan
- Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Timothy L McCavit
- Division of Hematology/Oncology, Cook Children's Medical Center, Fort Worth, Texas
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Powers JM, Buchanan GR, Adix L, Zhang S, Gao A, McCavit TL. Effect of Low-Dose Ferrous Sulfate vs Iron Polysaccharide Complex on Hemoglobin Concentration in Young Children With Nutritional Iron-Deficiency Anemia: A Randomized Clinical Trial. JAMA 2017; 317:2297-2304. [PMID: 28609534 PMCID: PMC5815003 DOI: 10.1001/jama.2017.6846] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Iron-deficiency anemia (IDA) affects millions of persons worldwide, and is associated with impaired neurodevelopment in infants and children. Ferrous sulfate is the most commonly prescribed oral iron despite iron polysaccharide complex possibly being better tolerated. OBJECTIVE To compare the effect of ferrous sulfate with iron polysaccharide complex on hemoglobin concentration in infants and children with nutritional IDA. DESIGN, SETTING, AND PARTICIPANTS Double-blind, superiority randomized clinical trial of infants and children aged 9 to 48 months with nutritional IDA (assessed by history and laboratory criteria) that was conducted in an outpatient hematology clinic at a US tertiary care hospital from September 2013 through November 2015; 12-week follow-up ended in January 2016. INTERVENTIONS Three mg/kg of elemental iron once daily as either ferrous sulfate drops or iron polysaccharide complex drops for 12 weeks. MAIN OUTCOMES AND MEASURES Primary outcome was change in hemoglobin over 12 weeks. Secondary outcomes included complete resolution of IDA (defined as hemoglobin concentration >11 g/dL, mean corpuscular volume >70 fL, reticulocyte hemoglobin equivalent >25 pg, serum ferritin level >15 ng/mL, and total iron-binding capacity <425 μg/dL at the 12-week visit), changes in serum ferritin level and total iron-binding capacity, adverse effects. RESULTS Of 80 randomized infants and children (median age, 22 months; 55% male; 61% Hispanic white; 40 per group), 59 completed the trial (28 [70%] in ferrous sulfate group; 31 [78%] in iron polysaccharide complex group). From baseline to 12 weeks, mean hemoglobin increased from 7.9 to 11.9 g/dL (ferrous sulfate group) vs 7.7 to 11.1 g/dL (iron complex group), a greater difference of 1.0 g/dL (95% CI, 0.4 to 1.6 g/dL; P < .001) with ferrous sulfate (based on a linear mixed model). Proportion with a complete resolution of IDA was higher in the ferrous sulfate group (29% vs 6%; P = .04). Median serum ferritin level increased from 3.0 to 15.6 ng/mL (ferrous sulfate) vs 2.0 to 7.5 ng/mL (iron complex) over 12 weeks, a greater difference of 10.2 ng/mL (95% CI, 6.2 to 14.1 ng/mL; P < .001) with ferrous sulfate. Mean total iron-binding capacity decreased from 501 to 389 μg/dL (ferrous sulfate) vs 506 to 417 μg/dL (iron complex) (a greater difference of -50 μg/dL [95% CI, -86 to -14 μg/dL] with ferrous sulfate; P < .001). There were more reports of diarrhea in the iron complex group than in the ferrous sulfate group (58% vs 35%, respectively; P = .04). CONCLUSIONS AND RELEVANCE Among infants and children aged 9 to 48 months with nutritional iron-deficiency anemia, ferrous sulfate compared with iron polysaccharide complex resulted in a greater increase in hemoglobin concentration at 12 weeks. Once daily, low-dose ferrous sulfate should be considered for children with nutritional iron-deficiency anemia. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01904864.
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Affiliation(s)
- Jacquelyn M. Powers
- Division of Hematology and Oncology, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston
| | - George R. Buchanan
- Division of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
- Children’s Health, Dallas, Texas
| | | | - Song Zhang
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Ang Gao
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Timothy L. McCavit
- Division of Hematology and Oncology, Cook Children’s Medical Center, Ft Worth, Texas
- Department of Pediatrics, Cook Children’s Medical Center, Ft Worth, Texas
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Cooke AG, McCavit TL, Buchanan GR, Powers JM. Iron Deficiency Anemia in Adolescents Who Present with Heavy Menstrual Bleeding. J Pediatr Adolesc Gynecol 2017; 30:247-250. [PMID: 27789349 DOI: 10.1016/j.jpag.2016.10.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 06/08/2016] [Revised: 10/09/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To assess the clinical severity and initial treatment of iron deficiency anemia (IDA) in female adolescents with heavy menstrual bleeding (HMB) in our center. DESIGN Retrospective cohort study of electronic medical records via search of administrative records using International Classification of Diseases Ninth Revision codes for IDA or unspecified anemia and disorders of menstruation. SETTING Children's Medical Center in Dallas, Texas. PARTICIPANTS One hundred seven patients with HMB and concomitant IDA (median age, 14.4 years) who presented to the outpatient, emergency department, and/or inpatient settings. RESULTS The median initial hemoglobin concentration for all patients (n = 107) was 7.4 g/dL, and most (74%, n = 79) presented to the emergency department or via inpatient transfer. Symptomatic IDA was treated with blood transfusion in 46 (43%, n = 46). Ferrous sulfate was the most commonly prescribed oral iron therapy. Seven patients received intravenous iron therapy either initially or after oral iron treatment failure. Combined oral contraceptives were commonly prescribed for abnormal uterine bleeding, yet 10% of patients (n = 11) received no hormonal therapy during their initial management. Evaluation for underlying bleeding disorders was inconsistent. CONCLUSION Severe anemia because of IDA and HMB resulting in urgent medical care, including hospitalization and blood transfusion, is a common but underemphasized problem in adolescent girls. In addition to prevention and early diagnosis, meaningful efforts to improve initial management of adolescents with severe HMB and IDA are necessary.
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Affiliation(s)
- Amanda G Cooke
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Timothy L McCavit
- Division of Hematology-Oncology, Department of Pediatrics, Cook Children's Hospital, Fort Worth, Texas
| | - George R Buchanan
- Division of Hematology-Oncology, Department of Pediatrics, UT Southwestern Medical Center and Children's Medical Center, Dallas, Texas
| | - Jacquelyn M Powers
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
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Powers JM, Shamoun M, McCavit TL, Adix L, Buchanan GR. Intravenous Ferric Carboxymaltose in Children with Iron Deficiency Anemia Who Respond Poorly to Oral Iron. J Pediatr 2017; 180:212-216. [PMID: 27776750 DOI: 10.1016/j.jpeds.2016.09.053] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/28/2016] [Accepted: 09/19/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess the benefits and risks of intravenous (IV) ferric carboxymaltose (FCM) in children with iron deficiency anemia (IDA). STUDY DESIGN In a retrospective cohort study of patients seen at our center, we identified all FCM infusions in children with IDA over a 12-month period through a query of pharmacy records. Clinical data, including hematologic response and adverse effects, were extracted from the electronic medical record. RESULTS A total of 116 IV FCM infusions were administered to 72 patients with IDA refractory to oral iron treatment (median age, 13.7 years; range, 9 months to 18 years). Median preinfusion and postinfusion hemoglobin values were 9.1 g/dL and 12.3 g/dL, respectively (at 4-12 weeks after the initial infusion; n = 53). Sixty-five patients (84%) experienced no adverse effects. Minor transient complications were encountered during or immediately after 7 infusions. CONCLUSION FCM administered as a short IV infusion without a test dose proved to be safe and highly effective in a small yet diverse population of infants, children, and adolescents with IDA refractory to oral iron therapy.
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Affiliation(s)
- Jacquelyn M Powers
- Division of Hematology/Oncology, Baylor College of Medicine, Houston, TX; Department of Pediatrics, Baylor College of Medicine, Houston, TX; Texas Children's Hospital, Houston, TX.
| | - Mark Shamoun
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX; Children's Health, Dallas, TX
| | - Timothy L McCavit
- Division of Hematology/Oncology, Cook Children's Hospital, Fort Worth, TX; Department of Pediatrics, Cook Children's Hospital, Fort Worth, TX
| | | | - George R Buchanan
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX; Children's Health, Dallas, TX; Division of Hematology/Oncology, The University of Texas Southwestern Medical Center, Dallas, TX
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Powers JM, Daniel CL, McCavit TL, Buchanan GR. Deficiencies in the Management of Iron Deficiency Anemia During Childhood. Pediatr Blood Cancer 2016; 63:743-5. [PMID: 26728130 PMCID: PMC4755821 DOI: 10.1002/pbc.25861] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/10/2015] [Indexed: 11/06/2022]
Abstract
Limited high-quality evidence supports the management of iron deficiency anemia (IDA). To assess our institutional performance in this area, we retrospectively reviewed IDA treatment practices in 195 consecutive children referred to our center from 2006 to mid-2010. The majority of children were ≤4 years old (64%) and had nutritional IDA (74%). In 11- to 18-year-old patients (31%), the primary etiology was menorrhagia (42%). Many were referred directly to the emergency department and/or prescribed iron doses outside the recommended range. Poor medication adherence and being lost-to-follow-up were common. Substantial improvements are required in the management of IDA.
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Affiliation(s)
- Jacquelyn M. Powers
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX,Children’s Health, Dallas, TX
| | - Catherine L. Daniel
- Department of Internal Medicine, The University of Pennsylvania, Philadelphia, PA
| | - Timothy L. McCavit
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX,Children’s Health, Dallas, TX
| | - George R. Buchanan
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX,Children’s Health, Dallas, TX
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Powers JM, McCavit TL, Buchanan GR. Management of iron deficiency anemia: a survey of pediatric hematology/oncology specialists. Pediatr Blood Cancer 2015; 62:842-6. [PMID: 25663613 PMCID: PMC4376588 DOI: 10.1002/pbc.25433] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 11/13/2014] [Accepted: 12/23/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Iron deficiency anemia (IDA) is the most common hematologic condition in children and adolescents in the United States (US). No prior reports have described the management of IDA by a large cohort of pediatric hematology/oncology specialists. PROCEDURE A 20-question electronic survey that solicited responses to two hypothetical cases of IDA was sent to active members of the American Society of Pediatric Hematology/Oncology (ASPHO) in the US. RESULTS Of 1,217 recipients, 398 (32.7%) reported regularly treating IDA and completed the survey. In a toddler with nutritional IDA, 15% (N = 61) of respondents reported ordering no diagnostic test beyond a complete blood count. Otherwise, wide variability in laboratory testing was reported. For treatment, most respondents would prescribe ferrous sulfate (N = 335, 84%) dosed at 6 mg/kg/day (N = 248, 62%) divided twice daily (N = 272, 68%). The recommended duration of iron treatment after resolution of anemia and normalized serum ferritin varied widely from 0 to 3 months. For an adolescent with heavy menstrual bleeding and IDA, most respondents recommended ferrous sulfate (N = 327, 83%), with dosing based on the number of tablets daily. For IDA refractory to oral treatment, intravenous iron therapy was recommended most frequently, 48% (N = 188) using iron sucrose, 17% (N = 68) ferric gluconate, and 15% (N = 60) low molecular weight iron dextran. CONCLUSION The approach to diagnosis and treatment of IDA in childhood was widely variable among responding ASPHO members. Given the lack of an evidence base to guide clinical decision making, further research investigating IDA management is needed.
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Affiliation(s)
- Jacquelyn M. Powers
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Timothy L. McCavit
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX,Children’s Medical Center, Dallas, TX
| | - George R. Buchanan
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX,Children’s Medical Center, Dallas, TX
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Abstract
BACKGROUND AND OBJECTIVE Time to opioid administration (TTO) has been suggested as a quality of care measure for sickle cell disease patients with vaso-occlusive crisis (VOC). We sought to determine whether TTO was associated with outcomes of emergency department (ED) visits for VOC. METHODS We conducted a single-center retrospective cohort study of ED visits for VOC. The primary outcome was hospital admission, with secondary outcomes of change between the first 2 pain scores, area under the curve (AUC) for pain scores at 4 hours (pain score AUC), total ED length of stay, and total intravenous opioids. In both univariate and multivariate analyses, mixed regression (logistic for admission, linear for secondary outcome variables) was used to evaluate association of TTO with outcome. RESULTS In 177 subjects, 414 ED visits for VOC were identified. Inpatient admission occurred in 53% of visits. The median TTO for admitted patients was 86 minutes vs 87 minutes for those not admitted. TTO was not associated with inpatient admission in either univariate or multivariate analyses. In multivariate analyses with secondary outcomes, decreased TTO was associated with greater improvement between the first 2 pain scores, decreased pain score AUC, decreased total ED length of stay, and increased total opioids. CONCLUSIONS Although TTO was not associated with admission, it was independently associated with 4 important secondary outcomes: change in initial pain scores, pain score AUC, total ED length of stay, and total intravenous opioids. The association of a process measure, TTO, with these outcomes encourages the institution of TTO reduction efforts in the ED.
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Affiliation(s)
- Melissa D Mathias
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Timothy L McCavit
- Division of Hematology-Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas; and Center for Cancer and Blood Disorders, Children's Medical Center Dallas, Dallas, Texas
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DeBaun MR, Gordon M, McKinstry RC, Noetzel MJ, White DA, Sarnaik SA, Meier ER, Howard TH, Majumdar S, Inusa BPD, Telfer PT, Kirby-Allen M, McCavit TL, Kamdem A, Airewele G, Woods GM, Berman B, Panepinto JA, Fuh BR, Kwiatkowski JL, King AA, Fixler JM, Rhodes MM, Thompson AA, Heiny ME, Redding-Lallinger RC, Kirkham FJ, Dixon N, Gonzalez CE, Kalinyak KA, Quinn CT, Strouse JJ, Miller JP, Lehmann H, Kraut MA, Ball WS, Hirtz D, Casella JF. Controlled trial of transfusions for silent cerebral infarcts in sickle cell anemia. N Engl J Med 2014; 371:699-710. [PMID: 25140956 PMCID: PMC4195437 DOI: 10.1056/nejmoa1401731] [Citation(s) in RCA: 350] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Silent cerebral infarcts are the most common neurologic injury in children with sickle cell anemia and are associated with the recurrence of an infarct (stroke or silent cerebral infarct). We tested the hypothesis that the incidence of the recurrence of an infarct would be lower among children who underwent regular blood-transfusion therapy than among those who received standard care. METHODS In this randomized, single-blind clinical trial, we randomly assigned children with sickle cell anemia to receive regular blood transfusions (transfusion group) or standard care (observation group). Participants were between 5 and 15 years of age, with no history of stroke and with one or more silent cerebral infarcts on magnetic resonance imaging and a neurologic examination showing no abnormalities corresponding to these lesions. The primary end point was the recurrence of an infarct, defined as a stroke or a new or enlarged silent cerebral infarct. RESULTS A total of 196 children (mean age, 10 years) were randomly assigned to the observation or transfusion group and were followed for a median of 3 years. In the transfusion group, 6 of 99 children (6%) had an end-point event (1 had a stroke, and 5 had new or enlarged silent cerebral infarcts). In the observation group, 14 of 97 children (14%) had an end-point event (7 had strokes, and 7 had new or enlarged silent cerebral infarcts). The incidence of the primary end point in the transfusion and observation groups was 2.0 and 4.8 events, respectively, per 100 years at risk, corresponding to an incidence rate ratio of 0.41 (95% confidence interval, 0.12 to 0.99; P=0.04). CONCLUSIONS Regular blood-transfusion therapy significantly reduced the incidence of the recurrence of cerebral infarct in children with sickle cell anemia. (Funded by the National Institute of Neurological Disorders and Stroke and others; Silent Cerebral Infarct Multi-Center Clinical Trial ClinicalTrials.gov number, NCT00072761, and Current Controlled Trials number, ISRCTN52713285.).
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Affiliation(s)
- Michael R DeBaun
- From the Department of Pediatrics, Division of Hematology-Oncology, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University School of Medicine, Nashville (M.R.D.); Department of Ophthalmology and Visual Sciences, Division of Biostatistics (M.G.), Departments of Radiology and Pediatrics (R.C.M.), Neurology and Pediatrics (M.J.N.), and Psychology (D.A.W.), the Program in Occupational Therapy and Department of Pediatrics Hematology-Oncology (A.A.K.), and the Division of Biostatistics and Department of Internal Medicine (J.P.M.), Washington University School of Medicine, St. Louis; Department of Pediatrics, Division of Hematology-Oncology, Wayne State University, Detroit (S.A.S.); Center for Cancer and Blood Disorders, Children's National Medical Center, Department of Pediatrics, George Washington University Medical Center (E.R.M.), and Department of Pediatrics, Division of Hematology-Oncology, Georgetown University Hospital (C.E.G.) - all in Washington, DC; Department of Pediatrics, Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham (T.H.H.); Department of Pediatrics, Division of Hematology-Oncology, University of Mississippi Medical Center, Jackson (S.M.); Department of Paediatrics, Evelina Children's Hospital, St. Thomas' Hospital NHS Trust (B.P.D.I.), Department of Pediatric Hematology, Royal London Hospital, Barts Health NHS Trust (P.T.T.), and the Neurosciences Unit, Institute of Child Health, University College London (F.J.K.) - all in London; Hospital for Sick Children, Department of Paediatrics, Haematology-Oncology, University of Toronto, Toronto (M.K.-A.); Division of Hematology-Oncology, Department of Pediatrics, UT Southwestern Medical Center, Dallas (T.L.M.C.); Département Pédiatrie, Hôpital Intercommunal de Creteil, Creteil, France (A.K.); Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine, Houston (G.A.); Department of Pediatrics, Hematology-Oncology, Univer
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12
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Simko SJ, Tran HD, Jones J, Bilgi M, Beaupin LK, Coulter D, Garrington T, McCavit TL, Moore C, Rivera-Ortegón F, Shaffer L, Stork L, Turcotte L, Welsh EC, Hicks MJ, McClain KL, Allen CE. Clofarabine salvage therapy in refractory multifocal histiocytic disorders, including Langerhans cell histiocytosis, juvenile xanthogranuloma and Rosai-Dorfman disease. Pediatr Blood Cancer 2014; 61:479-87. [PMID: 24106153 PMCID: PMC4474604 DOI: 10.1002/pbc.24772] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [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: 08/01/2013] [Accepted: 08/21/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Existing therapies for recurrent or refractory histiocytoses, including Langerhans cell histiocytosis (LCH), juvenile xanthogranuloma (JXG), and Rosai-Dorfman disease (RDD), have limited effectiveness. We report our experience with using clofarabine as therapy in children with recurrent or refractory histiocytic disorders, including LCH (11 patients), systemic JXG (4 patients), and RDD (3 patients). METHODS Patients treated with clofarabine for LCH, JXG, or RDD by Texas Children's Hospital physicians or collaborators between May 2011 and January 2013 were reviewed for response and toxicity. RESULTS Patients were treated with a median of three chemotherapeutic regimens prior to clofarabine. Clofarabine was typically administered at 25 mg/m(2) /day for 5 days. Cycles were administered every 28 days for a median of six cycles (range: 2-8 cycles). Seventeen of 18 patients are alive. All surviving patients showed demonstrable improvement after two to four cycles of therapy, with 11 (61%) complete responses, 4 (22%) partial responses, and 2 patients still receiving therapy. Five patients experienced disease recurrence, but three of these subsequently achieved complete remission. All patients with JXG and RDD had complete or partial response at conclusion of therapy. Side effects included neutropenia in all patients. Recurring but sporadic toxicities included prolonged neutropenia, severe vomiting, and bacterial infections. CONCLUSION Clofarabine has activity against LCH, JXG, and RDD in heavily pretreated patients, but prospective multi-center trials are warranted to determine long-term efficacy, optimal dosing, and late toxicity of clofarabine in this population.
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Affiliation(s)
- Stephen J. Simko
- Baylor College of Medicine, Houston, TX,Texas Children’s Cancer and Hematology Centers, Houston, TX
| | | | | | - Mrinalini Bilgi
- Baylor College of Medicine, Houston, TX,Texas Children’s Cancer and Hematology Centers, Houston, TX
| | | | - Don Coulter
- University of Nebraska Medical Center, Omaha, NE
| | | | | | | | | | | | - Linda Stork
- Oregon Health and Science University, Portland, OR
| | | | | | | | - Kenneth L. McClain
- Baylor College of Medicine, Houston, TX,Texas Children’s Cancer and Hematology Centers, Houston, TX
| | - Carl E. Allen
- Baylor College of Medicine, Houston, TX,Texas Children’s Cancer and Hematology Centers, Houston, TX
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Panepinto JA, Torres S, Bendo CB, McCavit TL, Dinu B, Sherman-Bien S, Bemrich-Stolz C, Varni JW. PedsQL™ Multidimensional Fatigue Scale in sickle cell disease: feasibility, reliability, and validity. Pediatr Blood Cancer 2014; 61:171-7. [PMID: 24038960 PMCID: PMC3848797 DOI: 10.1002/pbc.24776] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [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: 03/27/2013] [Accepted: 08/20/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is an inherited blood disorder characterized by a chronic hemolytic anemia that can contribute to fatigue and global cognitive impairment in patients. The study objective was to report on the feasibility, reliability, and validity of the PedsQL™ Multidimensional Fatigue Scale in SCD for pediatric patient self-report ages 5-18 years and parent proxy-report for ages 2-18 years. PROCEDURE This was a cross-sectional multi-site study whereby 240 pediatric patients with SCD and 303 parents completed the 18-item PedsQL™ Multidimensional Fatigue Scale. Participants also completed the PedsQL™ 4.0 Generic Core Scales. RESULTS The PedsQL™ Multidimensional Fatigue Scale evidenced excellent feasibility, excellent reliability for the Total Scale Scores (patient self-report α = 0.90; parent proxy-report α = 0.95), and acceptable reliability for the three individual scales (patient self-report α = 0.77-0.84; parent proxy-report α = 0.90-0.97). Intercorrelations of the PedsQL™ Multidimensional Fatigue Scale with the PedsQL™ Generic Core Scales were predominantly in the large (≥0.50) range, supporting construct validity. PedsQL™ Multidimensional Fatigue Scale Scores were significantly worse with large effects sizes (≥0.80) for patients with SCD than for a comparison sample of healthy children, supporting known-groups discriminant validity. Confirmatory factor analysis demonstrated an acceptable to excellent model fit in SCD. CONCLUSIONS The PedsQL™ Multidimensional Fatigue Scale demonstrated acceptable to excellent measurement properties in SCD. The results demonstrate the relative severity of fatigue symptoms in pediatric patients with SCD, indicating the potential clinical utility of multidimensional assessment of fatigue in patients with SCD in clinical research and practice.
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Affiliation(s)
- Julie A. Panepinto
- Department of Pediatrics, Children’s Hospital of Wisconsin of the Children’s Research Institute/Medical College of Wisconsin, Hematology/Oncology/Bone Marrow Transplantation; Milwaukee, WI
| | - Sylvia Torres
- Department of Pediatrics, Children’s Hospital of Wisconsin of the Children’s Research Institute/Medical College of Wisconsin, Hematology/Oncology/Bone Marrow Transplantation; Milwaukee, WI
| | - Cristiane B. Bendo
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Timothy L. McCavit
- Department of Pediatrics, University of Texas Southwestern Medical Center/Children’s Medical Center, Dallas, Texas
| | - Bogdan Dinu
- Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas
| | - Sandra Sherman-Bien
- Jonathan Jaques Children’s Cancer Center/Miller Children’s Hospital Long Beach, Long Beach, CA
| | | | - James W. Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station
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Plummer ES, Crary SE, McCavit TL, Buchanan GR. Intravenous low molecular weight iron dextran in children with iron deficiency anemia unresponsive to oral iron. Pediatr Blood Cancer 2013; 60:1747-52. [PMID: 23832487 DOI: 10.1002/pbc.24676] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 04/18/2013] [Accepted: 06/07/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND Iron deficiency anemia (IDA) in children is usually treated with oral iron, yet many respond poorly. Intravenous low molecular weight iron dextran (LMWID) offers the opportunity of employing a single outpatient infusion to correct the anemia and reduce the overall burden of treatment, but its use in children has been limited due to concerns of serious adverse effects. In this study we report our initial experience using LMWID in children with iron deficiency in whom oral iron was ineffective. METHODS We performed a case series of LMWID treatment of children with IDA of diverse etiologies who were poorly responsive to oral iron therapy with the aim of measuring its efficacy and adverse effects. LMWID was administered as a total dose infusion over 60 minutes in the outpatient setting. RESULTS Thirty-one patients age 11 months to 18 years received intravenous LMWID, and 24 were evaluable for hematologic response. Median hemoglobin increments were respectively 3.5, 1.9, and 1.8 g/dl in patients with IDA due to poor nutrition (n = 11), chronic blood loss (n = 13), and miscellaneous causes (n = 7). Two thirds of evaluable patients had a complete hematologic response. Nine of the patients (29%) had mild non-specific adverse effects upon initiation of the LMWID infusion. CONCLUSIONS LMWID as a total dose infusion was well tolerated and effective in a heterogeneous group of children and adolescents with IDA who were refractory to oral iron therapy. Transient reactions were common but not serious.
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Affiliation(s)
- Ellen S Plummer
- Division of Hematology-Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; Children's Medical Center, Dallas, Texas
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15
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Fletcher M, Hodgkiss H, Zhang S, Browning R, Hadden C, Hoffman T, Winick N, McCavit TL. Prompt administration of antibiotics is associated with improved outcomes in febrile neutropenia in children with cancer. Pediatr Blood Cancer 2013; 60:1299-306. [PMID: 23417978 DOI: 10.1002/pbc.24485] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 01/03/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND Time-to-antibiotic (TTA) administration is a widely used quality-of-care measure for children with cancer and febrile neutropenia (FN). We sought to determine whether TTA is associated with outcomes of FN. PROCEDURE A single-center, retrospective cohort study was conducted of 1,628 FN admissions from 653 patients from 2001 to 2009. Outcome variables included (1) an adverse event (AE) composite of in-hospital mortality, pediatric intensive care unit (PICU) admission within 24 hours of presentation, and/or fluid resuscitation ≥ 40 ml/kg within 24 hours of presentation and (2) length of stay (LOS). TTA was measured as a continuous variable and in 60-minute intervals. Mixed regression models were constructed to evaluate associations of TTA with the outcome variables after adjusting for relevant covariates including cancer diagnosis, degree of myelosuppression, and presence of bacteremia. RESULTS The composite AE outcome occurred in 11.1% of admissions including 0.7% in-hospital mortality, 4.7% PICU admission, and 10.1% fluid resuscitation. In univariate analysis, TTA was associated with the composite AE outcome (Odds Ratio [OR] 1.29, 95% CI 1.02-1.64) but not LOS. In multivariate analysis, after adjustment for relevant covariates, 60-minute TTA intervals were associated with the composite AE outcome (61-120 minutes vs. ≤ 60 minutes, OR 1.81, 95% CI 1.01-3.26). Unexpectedly, admission from the emergency department (ED) was also independently associated with the composite AE outcome (ED vs. clinic, OR 3.15, 95% CI 1.95-5.09). CONCLUSIONS TTA and presentation to the ED are independently associated with poor outcomes of FN.
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Affiliation(s)
- Matthew Fletcher
- Division of Hematology-Oncology, Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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16
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Panepinto JA, Torres S, Bendo CB, McCavit TL, Dinu B, Sherman-Bien S, Bemrich-Stolz C, Varni JW. PedsQL™ sickle cell disease module: feasibility, reliability, and validity. Pediatr Blood Cancer 2013; 60:1338-44. [PMID: 23441057 PMCID: PMC4412167 DOI: 10.1002/pbc.24491] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [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: 11/26/2012] [Accepted: 01/15/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is an inherited chronic disease that is characterized by complications such as recurrent painful vaso-occlusive events that require frequent hospitalizations and contribute to early mortality. The objective of the study was to report on the initial measurement properties of the new PedsQL™ SCD Module for pediatric patient self-report ages 5-18 years and parent proxy-report for ages 2-18 years. PROCEDURE The 43-item PedsQL™ SCD Module was completed in a multisite study by 243 pediatric patients with SCD and 313 parents. Participants also completed the PedsQL™ 4.0 Generic Core Scales and PedsQL™ Multidimensional Fatigue Scale. RESULTS The PedsQL™ SCD Module Scales evidenced excellent feasibility, excellent reliability for the Total Scale Scores (patient self-report α = 0.95; parent proxy-report α = 0.97), and good reliability for the nine individual scales (patient self-report α = 0.69-0.90; parent proxy-report α = 0.83-0.97). Intercorrelations with the PedsQL™ Generic Core Scales and PedsQL™ Multidimensional Fatigue Scales were medium (0.30) to large (0.50) range, supporting construct validity. PedsQL™ SCD Module Scale Scores were generally worse for patients with severe versus mild disease. Confirmatory factor analysis demonstrated an acceptable to excellent model fit. CONCLUSIONS The PedsQL™ SCD Module demonstrated acceptable measurement properties. The PedsQL™ SCD Module may be utilized in the evaluation of SCD-specific health-related quality of life in clinical research and practice. In conjunction with the PedsQL™ Generic Core Scales and the PedsQL™ Multidimensional Fatigue Scale, the PedsQL™ SCD Module will facilitate the understanding of the health and well-being of children with SCD.
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Affiliation(s)
- Julie A. Panepinto
- Department of Pediatrics, Children’s Hospital of Wisconsin of the Children’s Research Institute/Medical College of Wisconsin, Hematology/Oncology/Bone Marrow Transplantation; Milwaukee, WI
| | - Sylvia Torres
- Department of Pediatrics, Children’s Hospital of Wisconsin of the Children’s Research Institute/Medical College of Wisconsin, Hematology/Oncology/Bone Marrow Transplantation; Milwaukee, WI
| | - Cristiane B. Bendo
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Timothy L. McCavit
- Department of Pediatrics, University of Texas Southwestern Medical Center/Children’s Medical Center, Dallas, Texas
| | - Bogdan Dinu
- Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas
| | - Sandra Sherman-Bien
- Jonathan Jaques Children’s Cancer Center/Miller Children’s Hospital Long Beach, Long Beach, CA
| | | | - James W. Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station
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McCavit TL, Gilbert M, Buchanan GR. Prophylactic penicillin after 5 years of age in patients with sickle cell disease: a survey of sickle cell disease experts. Pediatr Blood Cancer 2013. [PMID: 23193095 DOI: 10.1002/pbc.24395] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Since the publication of the Prophlyactic Penicillin Study II in 1995, the management of penicillin prophylaxis for children with sickle cell disease (SCD) after 5 years of age has been controversial. In this study, we sought to describe current practice patterns of pediatric hematologists related to cessation of penicillin prophylaxis for children with SCD after 5 years of age. PROCEDURE We performed a cross-sectional, electronic survey of pediatric hematologists with expertise in SCD to examine practices regarding penicillin prophylaxis in children with SCD after 5 years of age. We also investigated factors potentially associated with continuation of penicillin prophylaxis using the Jonckheere-Terpstra test and Fisher's exact test. RESULTS Of the 106 physicians surveyed from 76 centers, 84% completed the survey. Among respondents, 76% routinely recommended cessation of penicillin prophylaxis after 5 years of age. The practice of routinely continuing penicillin after 5 years of age was associated with decreased concern about antibiotic resistance in Streptococcus pneumoniae (P = 0.01), with the usage of prophylactic penicillin in mild SCD genotypes (sickle hemoglobin-C disease and sickle β(+) thalassemia, P = <0.001), and with increasing use of other preventive evaluations (e.g., MRI for silent stroke) in childhood (P = 0.05). CONCLUSION Most pediatric hematologists with an SCD expertise recommend cessation of prophylactic penicillin after 5 years of age.
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Affiliation(s)
- Timothy L McCavit
- Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9063, USA.
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McCavit TL, Xuan L, Zhang S, Flores G, Quinn CT. National trends in incidence rates of hospitalization for stroke in children with sickle cell disease. Pediatr Blood Cancer 2013; 60:823-7. [PMID: 23151905 PMCID: PMC4250091 DOI: 10.1002/pbc.24392] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [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: 07/05/2012] [Accepted: 10/11/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND The success of primary stroke prevention for children with sickle cell disease (SCD) throughout the United States is unknown. Therefore, we aimed to generate national incidence rates of hospitalization for stroke in children with sickle cell disease (SCD) before and after publication of the Stroke Prevention Trial in Sickle Cell Anemia (STOP trial) in 1998. PROCEDURE We performed a retrospective trend analysis of the 1993-2009 Nationwide Inpatient Sample and Kids' Inpatient Databases. Hospitalizations for SCD patients 0-18 years old with stroke were identified by ICD-9CM code. The primary outcome, the trend in annual incidence rate of hospitalization for stroke in children with SCD, was analyzed by linear regression. Incidence rates of hospitalization for stroke before and after 1998 were compared by the Wilcoxon rank-sum test. RESULTS From 1993 to 2009, 2,024 hospitalizations were identified for stroke. Using the mean annual incidence rate of hospitalization for stroke from 1993 to 1998 as the baseline, the rate decreased from 1993 to 2009 (point estimate = -0.022/100 patient years [95% CI, -0.039, -0.005], P = 0.027). The mean annual incidence rate of hospitalization stroke decreased by 45% from 0.51 per 100 patient years in 1993-1998 to 0.28 per 100 patient years in 1999-2009 (P = 0.008). Total hospital days and charges attributed to stroke also decreased by 45% and 24%, respectively. CONCLUSIONS After publication of the STOP trial and hydroxyurea licensure in 1998, the incidence of hospitalization for stroke in children with SCD decreased across the United States, suggesting that primary stroke prevention has been effective nationwide, but opportunity for improvement remains.
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Affiliation(s)
- Timothy L. McCavit
- Division of Pediatric Hematology–Oncology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
,Children’s Medical Center Dallas, Dallas, Texas
,Correspondence to: University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9063.
| | - Lei Xuan
- Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Song Zhang
- Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Glenn Flores
- Children’s Medical Center Dallas, Dallas, Texas
,Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
,Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Charles T. Quinn
- Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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McCavit TL, Xuan L, Zhang S, Flores G, Quinn CT. Hospitalization for invasive pneumococcal disease in a national sample of children with sickle cell disease before and after PCV7 licensure. Pediatr Blood Cancer 2012; 58:945-9. [PMID: 21793185 PMCID: PMC4248562 DOI: 10.1002/pbc.23259] [Citation(s) in RCA: 33] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 06/07/2011] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To estimate national hospitalization rates for invasive pneumococcal disease (IPD) in children with sickle cell disease (SCD) before and after the 2000 licensure of the heptavalent pneumococcal conjugate vaccine (PCV7). PROCEDURE We performed a retrospective trend analysis of the 1994-2007 Nationwide Inpatient Sample databases. Hospitalizations involving children with SCD and IPD were identified by ICD-9CM code. The primary outcomes, the annual hospitalization rate for IPD in children with SCD and the proportion of hospitalizations for IPD per 100 total SCD hospitalizations, were analyzed using multivariable linear regression and contingency analysis, respectively. RESULTS A total of 1,242 hospitalizations for IPD in SCD patients were identified from 1994-2007, with a mortality rate of 2.4%. The national mean annual rate of IPD hospitalization decreased by 65%, from 131.8 cases/year from 1994 to 2000 to 45.5 cases/year from 2001 to 2007 (P = 0.001). The national proportion of hospitalizations for IPD per 100 total SCD hospitalizations decreased from 0.4 to 0.15 (P < 0.0001) over the same interval. Following PCV7 licensure, the mean annual cumulative hospital days and cumulative hospital charges decreased nationally by 53% and 36%, respectively. CONCLUSION In a national sample, PCV7 licensure is temporally associated with a nearly threefold reduction in IPD hospitalizations in children with SCD.
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Affiliation(s)
- Timothy L. McCavit
- Division of Pediatric Hematology-Oncology, University of Texas Southwestern Medical Center at Dallas, TX, USA,Children's Medical Center Dallas, Dallas, TX, USA
| | - Lei Xuan
- Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas, TX, USA
| | - Song Zhang
- Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas, TX, USA
| | - Glenn Flores
- Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, TX, USA,Children's Medical Center Dallas, Dallas, TX, USA
| | - Charles T. Quinn
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Affiliation(s)
- Timothy L McCavit
- Division of Hematology-Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
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McCavit TL, Winick N. Time-to-antibiotic administration as a quality of care measure in children with febrile neutropenia: a survey of pediatric oncology centers. Pediatr Blood Cancer 2012; 58:303-5. [PMID: 21509930 PMCID: PMC3150359 DOI: 10.1002/pbc.23148] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [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: 01/23/2011] [Accepted: 03/11/2011] [Indexed: 11/09/2022]
Abstract
Time-to-antibiotic administration (TTA) has been suggested as a quality-of-care (QOC) measure for pediatric oncology patients with febrile neutropenia (FN). Unknown, however, is to what extent pediatric oncology centers utilize TTA. Therefore, we designed and administered an electronic survey (68% response rate) of programs in the Children's Oncology Group to assess TTA utilization. Nearly half of respondents track TTA. Most reported using a benchmark of less than 60 min from arrival. TTA is a commonly used QOC measure for pediatric FN despite an absence of studies establishing its validity and a lack of data supporting its impact on outcomes of FN.
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Affiliation(s)
- Timothy L. McCavit
- Division of Hematology-Oncology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA,Center for Cancer and Blood Disorders, Children's Medical Center Dallas, Dallas, TX, USA
| | - Naomi Winick
- Division of Hematology-Oncology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA,Center for Cancer and Blood Disorders, Children's Medical Center Dallas, Dallas, TX, USA
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McCavit TL, Lin H, Zhang S, Ahn C, Quinn CT, Flores G. Hospital volume, hospital teaching status, patient socioeconomic status, and outcomes in patients hospitalized with sickle cell disease. Am J Hematol 2011; 86:377-80. [PMID: 21442644 DOI: 10.1002/ajh.21977] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Sickle cell disease (SCD) accounts for ~100,000 hospitalizations in the US annually. Quality of care for hospitalized SCD patients has been insufficiently studied. Therefore, we aimed to examine whether four potential determinants of quality care, [1] hospital volume, [2] hospital teaching status, [3] patient socioeconomic status (SES), and [4] patient insurance status, are associated with three quality indicators for patients with SCD: [1] mortality, [2] length of stay (LOS), and [3] hospitalization costs. We conducted an analysis of the 2003–2005 Nationwide Inpatient Sample (NIS) datasets. We identified cases using all ICD-9CM codes for SCD. Both overall and SCD-specific hospital volumes were examined. Multivariable analyses included mixed linear models to examine LOS and costs, and logistic regression to examine mortality. About 71,481 SCD discharges occurred from 2003 to 2005. Four hundred and twenty five patients died, yielding a mortality rate of 0.6%. Multivariable analyses revealed that SCD patients admitted to lower SCD-specific volume hospitals had [1] increased adjusted odds of mortality (quintiles 1–4 vs. quintile 5: OR, 1.36; 95% CI, 1.05, 1.76) and [2] decreased LOS (quintiles 1–4 vs. quintile 5, effect estimate 20.08; 95%CI, 20.12, 20.04). These are the first data describing associations between lower SCD-specific hospital volumes and poorer outcomes.
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Affiliation(s)
- Timothy L McCavit
- Division of Pediatric Hematology-Oncology, University of Texas Southwestern Medical Center at Dallas, and Children's Medical Center Dallas, TX 75390, USA.
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McCavit TL, Quinn CT, Techasaensiri C, Rogers ZR. Increase in invasive Streptococcus pneumoniae infections in children with sickle cell disease since pneumococcal conjugate vaccine licensure. J Pediatr 2011; 158:505-7. [PMID: 21193205 PMCID: PMC3062091 DOI: 10.1016/j.jpeds.2010.11.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [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: 06/16/2010] [Revised: 09/07/2010] [Accepted: 11/08/2010] [Indexed: 11/26/2022]
Abstract
Invasive pneumococcal disease (IPD) in children with sickle cell disease has decreased with prophylactic penicillin, pneumococcal polysaccharide vaccine, and pneumococcal protein-conjugate vaccine usage. We report 10 IPD cases since pneumococcal protein-conjugate vaccine licensure, including a recent surge of non-vaccine serotypes. IPD continues to be a serious risk in sickle cell disease.
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Affiliation(s)
- Timothy L. McCavit
- Division of Hematology-Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, Center for Cancer and Blood Disorders, Children’s Medical Center Dallas, Dallas, TX, USA
| | - Charles T. Quinn
- Division of Hematology-Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, Center for Cancer and Blood Disorders, Children’s Medical Center Dallas, Dallas, TX, USA
| | - Chonnamet Techasaensiri
- Division of Infectious Diseases, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, Center for Cancer and Blood Disorders, Children’s Medical Center Dallas, Dallas, TX, USA
| | - Zora R. Rogers
- Division of Hematology-Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, Center for Cancer and Blood Disorders, Children’s Medical Center Dallas, Dallas, TX, USA
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Abstract
Patients with sickle cell disease (SCD) have an increased risk of invasive bacterial infection because of hyposplenism. Bordetella holmesii is a recently described Gram-negative coccobacillus with an apparent predilection for asplenic hosts. We report two patients with SCD and B. holmesii bacteremia. Fastidious growth in culture and a typically uncomplicated clinical course distinguish B. holmesii infection from other invasive bacterial infections in SCD. Providers for patients with SCD should be aware of this pathogen and ensure that their microbiology laboratories are capable of isolating and identifying this organism.
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Affiliation(s)
- Timothy L McCavit
- Division of Hematology-Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9063, USA.
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