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Di Maio S, Marzuillo P, Daar S, Kattamis C, Karimi M, Forough S, Banchev A, Kaleva V, Christou S, Fortugno C, Delaporta P, Soliman AT, Tzoulis P, de Sanctis V. A Multicenter ICET-A Study on Age at Menarche and Menstrual Cycles in Patients with Transfusion-Dependent Thalassemia (TDT) who Started Early Chelation Therapy with Different Chelating Agents. Mediterr J Hematol Infect Dis 2023; 15:e2023058. [PMID: 38028391 PMCID: PMC10631706 DOI: 10.4084/mjhid.2023.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction To evaluate the effect of early chelation therapy (≤ 3 years) with a variety of chelating agents on age at menarche and menstrual characteristics in patients with transfusion-dependent thalassemia (TDT). Design A retrospective multicenter study promoted by the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescent Medicine (ICET-A). Setting Eight of 13 International Thalassemia Centers (61.5%) in the ICET-A Network participated. Patients Fifty-seven female TDT patients, aged 11 to 26 years, and with early iron chelation therapy, were eligible for the present study. They were enrolled from one center from Iran (33 patients), 3 centers from Bulgaria (9), 1 from Greece (8), one from Oman (4), 1 from Cyprus (2), and 1 from Italy (1). Seven patients were excluded, four still prepubertal (age 12-14 years) and 3 with primary amenorrhea. Therefore 50 patients were finally enrolled. Results All fifty TDT patients developed spontaneous menarche at a mean age of 14.2 ± 2.24 years (range 9 - 20). A significant positive correlation was observed between age at menarche and serum ferritin levels (r: 0. 41, p=0.005). Regular menstrual cycles were reported from 32 (64%) patients, of whom 28 (83.3%) get menarche at age ≤ 14 years. Complications were more frequent in patients older than 14 years at menarche and in those with secondary amenorrhea. Conclusions Age at menarche greater than 14 years was a forerunner of menstrual irregularities and associated complications in 36% of patients despite precocious chelation therapy. The poor adherence to treatment, to be demonstrated in future studies, could explain the finding.
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Affiliation(s)
- Salvatore Di Maio
- Emeritus Director in Pediatrics, Children’s Hospital “Santobono-Pausilipon,” Naples, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child, General and Specialized Surgery, University “Luigi Vanvitelli,” Naples, Italy
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman and Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch, South Africa
| | - Christos Kattamis
- First Department of Paediatrics, National Kapodistrian University of Athens, Athens, Greece
| | - Mehran Karimi
- Department of Hematology-Oncology, American Hospital Dubai, UAE
| | - Saki Forough
- Shiraz Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Atanas Banchev
- Expert Center for Haemophilia, Thalassemia and Other Rare Benign Haematological Disorders, Department of Paediatric Haematology and Oncology, University Hospital “Tzaritza Giovanna – ISUL,” Medical University, Sofia, Bulgaria
| | - Valeria Kaleva
- Expert Center for Coagulopathies and Rare Anemias, Varna, Bulgaria
| | | | - Carmelo Fortugno
- Department of Pediatric Haematoncology, Thalassaemia and Prenatal Diagnosis Regional Center, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Polyxeni Delaporta
- Thalassemia Unit, First Department of Pediatrics National Kapodistrian University of Athens, Athens, Greece
| | | | - Ploutarchos Tzoulis
- Department of Endocrinology, Whittington Hospital, University College London, London, UK
| | - Vincenzo de Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
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Güvenç U, Ünlü N, Yaralı HN, Özbek NY. Does thalassemia truly cause microvascular changes without us noticing? An optical coherence tomography angiography study of the children with beta-thalassemia. Int Ophthalmol 2023; 43:3755-3765. [PMID: 37389762 DOI: 10.1007/s10792-023-02786-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE It was aimed to evaluate the retinochoroidal microvascular alterations of pediatric beta-thalassemia patients and investigate the effect of blood transfusion on perfusion among transfusion-dependent thalassemia (TDT), by means of optical coherence tomography angiography (OCTA). METHODS In this multicentered, prospective, cross-sectional study, 56 TDT, 14 non-TDT (NTDT), and 63 healthy children were evaluated. The vessel density (VD) in superficial capillary plexus (SCP), deep capillary plexus, radial peripapillary capillary network, choriocapillaris, and the foveal avascular zone area (FAZ) were evaluated by OCTA. Before and after transfusion values of the TDT group were compared, and correlations were made with blood values and iron accumulation. RESULTS Foveal and parafoveal zones were significantly thinner among TDT patients, with larger FAZ area. Macula VD of SCP and ppVD was lowest in NTDT group. In the TDT group, a decrease in retinal nerve fiber thickness and ppVD values was detected after transfusion. A negative significant relationship was found between both hemoglobin (Hb), hematocrit (Htc), and ppVD. CONCLUSIONS OCTA provides a better insight into retinal and choriocapillaris vascular impairment influenced by tissue hypoxia and oxidative stress in different clinical phenotypes of beta-thalassemia.
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Affiliation(s)
- Umay Güvenç
- Ankara Training and Research Hospital Ophthalmology Department, Ankara, Turkey.
| | - Nurten Ünlü
- Ankara Training and Research Hospital Ophthalmology Department, Ankara, Turkey
| | - Hüsniye Neşe Yaralı
- Ankara City Hospital Pediatric Hematology and Oncology Department, Ankara, Turkey
| | - Namık Yaşar Özbek
- Ankara City Hospital Pediatric Hematology and Oncology Department, Ankara, Turkey
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Grewal A, Kakkar S, Dewan P, Bansal N, Sobti PC, Eleftheriou P. Prevalence, Severity, and Determinants of Pain in Thalassemia. Hemoglobin 2023; 47:191-197. [PMID: 37982258 DOI: 10.1080/03630269.2023.2269846] [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: 07/29/2022] [Accepted: 10/07/2023] [Indexed: 11/21/2023]
Abstract
As the life expectancy in thalassemia is improving, pain is being recognized as an emerging problem. To document the pain prevalence and severity in patients with transfusion-dependent thalassemia all transfusion-dependent thalassemia patients >10 years of age (n = 165) attending the Thalassemia Day Care Center were assessed for pain prevalence, severity, and its effect on various life activities using the Brief Pain Inventory. Their medical records were reviewed for the presence of various co-morbidities. Pain was reported by 62.4% of participants with 35.2% and 59.4% of participants, reporting pain in the past 1 and 4 weeks respectively. A significantly higher pain prevalence was reported in females (p = .037), patients residing in urban areas (p = .038), and employed participants (p = .038). The commonest sites of pain were the lower back and calves. General activity (p = .02) and enjoyment of life (p = .02) were significantly affected due to pain in patients between 21 and 30 years of age. Female participants reported interference of pain with mood (p = .03). A significant correlation of pain prevalence was found with higher average serum ferritin (p = .015), moderate to severe liver iron concentration (p = .04), and lower levels of 25 hydroxyvitamin D levels (p = .03). Pain is an emerging cause of morbidity in thalassemia. The study found a significant association of pain with modifiable factors such as serum ferritin, LIC, and 25 (OH) vitamin D levels.
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Affiliation(s)
- Amanat Grewal
- Dayanand Medical College and Hospital, Ludhiana, India
| | - Shruti Kakkar
- Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, India
| | | | - Namita Bansal
- Dayanand Medical College and Hospital, Ludhiana, India
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Kakkar S, Jain E, Jain A, Dewan P. Adverse Effects of COVID-19 Vaccination in Patients with Transfusion-Dependent Thalassemia: An Observational Study from a Tertiary Care Center in Punjab, India. Acta Haematol 2023; 146:391-396. [PMID: 37331336 DOI: 10.1159/000531448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/02/2023] [Indexed: 06/20/2023]
Abstract
Vaccination against SARS-CoV-2 is the most important weapon in the arsenal in the battle against COVID-19. There is concern about an increased risk of adverse effects in patients with transfusion-dependent thalassemia (TDT), which affects vaccine acceptance. A predesigned questionnaire was used to evaluate adverse effects (local/systemic within 90 days after vaccination) in participants >18 years of age with TDT. A total of 100 patients received 129 vaccine doses. The mean age of the patients was 24.3 ± 5.7 years, and M:F ratio of 1.6:1. Covishield (Serum Institute of India) was administered to 89% of the participants, and Covaxin (Bharat Biotech Limited) to 11% of the participants. Adverse effects were documented in 62% of the respondents and were more pronounced after the first dose (52%) compared to the second dose (9%). The most frequent adverse effects were pain at the injection site (43%) and fever (37%). All adverse effects were mild and none of the participants required hospitalization. There were no differences in adverse effects among different vaccines, in the presence or absence of comorbidities, blood groups, or ferritin levels. The SARS-CoV-2 vaccine appears to be safe for patients with TDT.
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Affiliation(s)
- Shruti Kakkar
- Associate Professor, Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, India
| | - Evani Jain
- Intern, Dayanand Medical College and Hospital, Ludhiana, India
| | - Anirudh Jain
- Intern, Dayanand Medical College and Hospital, Ludhiana, India
| | - Priyanka Dewan
- Child Psychologist, Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, India
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Ray S, Saikia D, Vashisht Y, Sharma S, Meena RK, Kumar M. Dyslipidemia and atherogenic indexes in children with transfusion-dependent thalassemia. Hematol Transfus Cell Ther 2023:S2531-1379(23)00075-5. [PMID: 37147168 DOI: 10.1016/j.htct.2023.02.006] [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: 09/17/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVE This study endeavored to assess the lipid profile and atherogenic lipid indexes in children with transfusion-dependent thalassemia (TDT) and to compare them with matched healthy children. METHOD The study group consisted of a total of 72 TDT patients aged 3 to14 years, while the control group had 83 age- and sex-matched healthy children. The fasting lipid profile and lipid indexes were estimated and the atherogenic index of plasma (AIP), Castelli's risk indexes I and II, atherogenic coefficient were calculated and compared between the two groups. RESULT Compared to the control group, the mean LDL, HDL and cholesterol levels were significantly lower among the case group (p-value < 0.001). The mean VLDL and triglycerides were significantly higher in the case group (p-value < 0.001). Lipid indexes, including the atherogenic index of plasma (AIP), Castelli's risk indexes I and II and atherogenic coefficients were significantly higher in TDT children. CONCLUSION Dyslipidemia and increased risk of atherosclerosis were found in TDT children, as they had elevated atherogenic lipid indexes. Our study underlines the importance of the routine use of these indexes in TDT children. Future studies should focus on lipid indexes in this high-lipid group of children so that preventive strategies can be planned accordingly.
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Affiliation(s)
| | - Diganta Saikia
- Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
| | | | - Shikha Sharma
- Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
| | | | - Manish Kumar
- Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
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Sayani FA, Singer ST, Carlberg KT, Vichinsky EP. Fertility and Pregnancy in Women with Transfusion-Dependent Thalassemia. Hematol Oncol Clin North Am 2023; 37:393-411. [PMID: 36907611 DOI: 10.1016/j.hoc.2022.12.008] [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] [Indexed: 03/12/2023]
Abstract
Because women with transfusion-dependent thalassemia are seeking pregnancy, ensuring the best outcomes for both mother and baby require concerted and collaborative efforts between the hematologist, obstetrician, cardiologist, hepatologist, and genetic counselor among others. Proactive counseling, early fertility evaluation, optimal management of iron overload and organ function, and application of advances in reproductive technology and prenatal screening are important in ensuring a healthy outcome. Many unanswered questions remain requiring further study, including fertility preservation, non-invasive prenatal diagnosis, chelation therapy during pregnancy, and indications and duration of anticoagulation.
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Affiliation(s)
- Farzana A Sayani
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Sylvia T Singer
- Division of Hematology/Oncology, UCSF Benioff Children's Hospital, 747 52nd Street, Oakland, CA 94609, USA
| | - Katie T Carlberg
- Division of Cancer and Blood Disorders, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Elliott P Vichinsky
- Division of Hematology/Oncology, UCSF Benioff Children's Hospital, 747 52nd Street, Oakland, CA 94609, USA
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Piyajaroenkij T, Tantiworawit A, Khikhuntod J, Piriyakhuntorn P, Rattanathammethee T, Hantrakool S, Chai-Adisaksopha C, Rattarittamrong E, Norasetthada L, Fanhchaksai K, Charoenkwan P, Thananchai H. Alteration of monocyte subsets and their functions in thalassemia patients. Int J Hematol 2023; 117:188-197. [PMID: 36323999 PMCID: PMC9889407 DOI: 10.1007/s12185-022-03484-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/07/2022]
Abstract
Infection is one of the leading causes of mortality in thalassemia patients. This study aimed to examine qualitative and quantitative changes in monocytes in thalassemia patients. Monocytes were isolated from peripheral blood mononuclear cells and separated into subpopulations by flow cytometry. Cytokine levels were measured using quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) and sandwich enzyme-linked immunosorbent assay (ELISA). The primary endpoint was monocyte-derived TNF-α expression. A total of 78 patients and 26 controls were included. The mean log (TNF-α fold-change) by qRT-PCR was significantly lower in all thalassemia groups, at 1.27 in controls, versus 0.97 (p = 0.0014) in non-transfusion-dependent thalassemia (NTDT), 0.96 (p = 0.0004) in non-splenectomized transfusion-dependent thalassemia (TDT-NS), and 0.87 (p < 0.0001) in splenectomized transfusion-dependent thalassemia (TDT-S). Similarly, the mean 2-h TNF-α level measured by sandwich ELISA assay was significantly lower in all thalassemia groups, at 98.16 pg/mL in controls, versus 56.45 pg/mL (p = 0.0093) in NTDT, 39.05 pg/mL (p = 0.0001) in TDT-NS and 32.37 pg/mL (p < 0.0001) in TDT-S. Likewise, TDT patients had a significantly decreased percentage of non-classical monocytes, by approximately half compared to controls. Our results show that thalassemia major patients have clearly impaired monocyte counts and function.
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Affiliation(s)
- Thanakrit Piyajaroenkij
- grid.7132.70000 0000 9039 7662Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intravaroros Road, A. Muang50200, Chiang Mai, Thailand ,grid.10223.320000 0004 1937 0490Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Adisak Tantiworawit
- grid.7132.70000 0000 9039 7662Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intravaroros Road, A. Muang50200, Chiang Mai, Thailand
| | - Jeeraphong Khikhuntod
- grid.7132.70000 0000 9039 7662Division of Immunology, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pokpong Piriyakhuntorn
- grid.7132.70000 0000 9039 7662Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intravaroros Road, A. Muang50200, Chiang Mai, Thailand
| | - Thanawat Rattanathammethee
- grid.7132.70000 0000 9039 7662Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intravaroros Road, A. Muang50200, Chiang Mai, Thailand
| | - Sasinee Hantrakool
- grid.7132.70000 0000 9039 7662Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intravaroros Road, A. Muang50200, Chiang Mai, Thailand
| | - Chatree Chai-Adisaksopha
- grid.7132.70000 0000 9039 7662Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intravaroros Road, A. Muang50200, Chiang Mai, Thailand
| | - Ekarat Rattarittamrong
- grid.7132.70000 0000 9039 7662Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intravaroros Road, A. Muang50200, Chiang Mai, Thailand
| | - Lalita Norasetthada
- grid.7132.70000 0000 9039 7662Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intravaroros Road, A. Muang50200, Chiang Mai, Thailand
| | - Kanda Fanhchaksai
- grid.7132.70000 0000 9039 7662Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pimlak Charoenkwan
- grid.7132.70000 0000 9039 7662Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Hathairat Thananchai
- grid.7132.70000 0000 9039 7662Division of Immunology, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Osataphan N, Dumnil S, Tantiworawit A, Punnachet T, Hantrakun N, Piriyakhuntorn P, Rattanathammethee T, Hantrakool S, Chai-Adisaksopha C, Rattarittamrong E, Norasetthada L, Fanhchaksai K, Charoenkwan P. The long-term efficacy in blood transfusions, hematologic parameter changes, and complications after splenectomy in patients with transfusion-dependent thalassemia. Transfus Apher Sci 2022;:103620. [PMID: 36509632 DOI: 10.1016/j.transci.2022.103620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND A splenectomy can reduce transfusion requirements in patients with thalassemia. However, the role of a splenectomy remains controversial because its efficacy has not yet been fully determined and there are concerns over potential complications. The purpose of this study was to assess the efficacy, potential changes in hematologic parameters, and any complications associated with splenectomy. METHODS Medical records of 50 patients with transfusion-dependent thalassemia (TDT) who had undergone a splenectomy, along with those of 20 control subjects with intact spleens, were retrospectively reviewed. RESULTS The primary outcomes indicate the efficacy of a splenectomy in reducing red cell transfusions. Fifty TDT post-splenectomy patients were included in this study, of which 28 (56%) were female. The median age of all patients was 20.5 (18-28 years of age). Twenty-seven patients (54%) transformed from TDT to non-transfusion-dependent thalassemia (NTDT) after the splenectomy; 100% with Hb H disease, 58.3% with beta-thalassemia/Hb E disease, and 23.5% with homozygous beta-thalassemia. According to multivariable logistic regression analysis, Hb H disease (adjusted OR 55.23, 95% CI 1.35-22.8.10) and receiving a splenectomy at > ten years of age (adjusted OR 25.36, 95% CI 1.62-396.47) were associated with higher responses. The prevalence of pulmonary hypertension and thromboembolic events were similar between the splenectomy patients and non-splenectomy patients. CONCLUSION Splenectomy reduced transfusion requirements in TDT patients. The predictive factors as a response to a splenectomy included Hb H disease amongthose receiving a splenectomy at > ten years of age.
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Mousa SO, Abd El-Hafez AH, Abu El-Ela MA, Mourad MAF, Saleh RN, Sayed SZ. RANK/RANKL/OPG axis genes relation to cognitive impairment in children with transfusion-dependent thalassemia: a cross-sectional study. BMC Pediatr 2022; 22:435. [PMID: 35858838 PMCID: PMC9297631 DOI: 10.1186/s12887-022-03479-9] [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: 03/02/2022] [Accepted: 07/06/2022] [Indexed: 01/19/2023] Open
Abstract
Background RANK/RANKL/OPG axis was implicated in many pathological conditions. The study aimed to assess the relationship between the studied RANK, RANKL, and OPG polymorphisms and alleles and cognitive impairment in children with transfusion-dependent thalassemia (TDT). Methods This study included 60 TDT children. Real-time PCR was done for: rs1805034, rs1245811, and rs75404003 polymorphisms for the RANK gene, rs9594782 and rs2277438 polymorphisms for the RANKL gene, and rs207318 polymorphism for the OPG gene. The intelligence quotient (IQ) was assessed using the Wechsler Intelligence Scale for Children-Third Edition. Results TDT children had a low average total IQ, verbal IQ, and borderline performance IQ. RANK rs1805034 (C > T) had a significant effect on total IQ (p = 0.03). Its TT polymorphism and the CT polymorphism of RANKL rs9494782 (C > T) had a significantly lower total IQ (p = 0.01 for both). The G allele of the RANKL rs2277438 (G > A) had a significantly lower total IQ (p = 0.02). RANK rs1805034 (C > T) and RANKL rs2277438 (G > A) significantly affected verbal IQ (p = 0.01 and 0.03). TT genotype of RANK rs1805034 (C > T) had significantly lower verbal IQ (p = 0.002). Furthermore, the GG genotype of RANKL rs2277438 (G > A) had a significantly lower verbal and performance IQ than the AA genotype (p = 0.04 and 0.01 respectively), and its G allele had a significantly lower performance IQ than the A allele (p = 0.02). Conclusion TDT children had low average total and verbal IQ while their performance IQ was borderline. The RANK/RANKL/OPG pathway affects cognition in TDT children, as some of the studied genes’ polymorphisms and alleles had significant effects on total, verbal, and performance IQ of the studied TDT children.
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Affiliation(s)
- Suzan Omar Mousa
- Department of Pediatrics, Children's University hospital, Faculty of Medicine, Minia University, El-Minya, Egypt.
| | - Asmaa Hosni Abd El-Hafez
- Department of Pediatrics, Children's University hospital, Faculty of Medicine, Minia University, El-Minya, Egypt
| | | | | | - Rasha Nady Saleh
- Department of Neuropsychiatry, Faculty of Medicine, El-Minya, Egypt
| | - Samira Zain Sayed
- Department of Pediatrics, Children's University hospital, Faculty of Medicine, Minia University, El-Minya, Egypt
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Mousa SO, Abd Alsamia EM, Moness HM, Mohamed OG. The effect of zinc deficiency and iron overload on endocrine and exocrine pancreatic function in children with transfusion-dependent thalassemia: a cross-sectional study. BMC Pediatr 2021; 21:468. [PMID: 34686155 PMCID: PMC8532363 DOI: 10.1186/s12887-021-02940-5] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/12/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Children with transfusion-dependent thalassemia (TDT) suffer from secondary hemosiderosis and the delirious effects this iron overload has on their different body organs, including the pancreas. They are also more prone to develop zinc deficiency than the general pediatric population. This study aimed to determine the effect of zinc deficiency and iron overload on the endocrine and exocrine pancreas in TDT children. METHODS Eighty children, already diagnosed with TDT, were included in this study. We assessed the following in the participant children: serum ferritin, serum zinc, endocrine pancreatic function (oral glucose tolerance test (OGTT), fasting insulin level and from them, HOMA-IR was calculated), and exocrine pancreatic function (serum lipase and serum amylase). RESULTS Forty-four TDT children had a subnormal zinc level, while 36 of them had a normal serum zinc level. TDT children with low serum zinc had significantly more impaired endocrine pancreatic function and an abnormally high serum lipase than children with normal serum zinc, p < 0.05 in all. Serum zinc was significantly lower in TDT children with serum ferritin above the ferritin threshold (≥2500 ng/ml) than those below (59.1 ± 20.2 vs. 77.5 ± 28.13), p = 0.02. TDT children, having a serum ferritin ≥2500 ng/ml, had significantly more frequently impaired endocrine pancreatic function and abnormally high serum lipase than TDT children below the ferritin threshold, p < 0.05 in all. CONCLUSION In children with transfusion-dependent thalassemia, zinc deficiency aggravates iron-induced pancreatic exocrine and endocrine dysfunction.
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Affiliation(s)
- Suzan O. Mousa
- Pediatric Department, Children’s University hospital, Faculty of Medicine, Minia University, El-Minya, Egypt
| | - Ebtihal M. Abd Alsamia
- Pediatric Department, Children’s University hospital, Faculty of Medicine, Minia University, El-Minya, Egypt
| | - Hend M. Moness
- Department of Clinical Pathology, Minia University hospitals, Minia University, El-Minya, Egypt
| | - Osama G. Mohamed
- Pediatric Department, Children’s University hospital, Faculty of Medicine, Minia University, El-Minya, Egypt
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Sevimli C, Yilmaz Y, Bayramoglu Z, Comert RG, Gul N, Dursun M, Karakas Z. Pancreatic MR imaging and endocrine complications in patients with beta-thalassemia: a single-center experience. Clin Exp Med 2021; 22:95-101. [PMID: 34245399 DOI: 10.1007/s10238-021-00735-7] [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: 01/08/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
Iron deposition in various organs can cause endocrine complications in patients with transfusion-dependent beta-thalassemia. The aim was to investigate the relationship between endocrine complications and pancreatic iron overload using magnetic resonance imaging (MRI). Forty patients with transfusion-dependent thalassemia (TDT) were enrolled in the study. The magnetic resonance imagings of the patients were performed using a 1.5 Tesla Philips MRI scanner. Two out of three patients had at least one clinical endocrine complication. The rate of iron deposition was 62.5% in liver, and 45% in pancreas tissue, and was 12.5% in heart tissue. Pancreatic T2* and hepatic T2* values were significantly positively correlated (p = 0.006). Pancreatic T2* and ferritin were significantly negatively correlated (p = 0.03). Cardiac T2* values were negatively correlated with fasting blood glucose (p = 0.03). Patients with short stature had significantly higher cardiac iron burden (22.3 vs. 36.6 T2*ms; p 0.01), and patients with hypothyroidism had higher liver iron concentrations (9.9 vs. 6.4 LIC mg/g; p = 0.05). The ferritin level of 841 ng/mL and liver iron concentration (LIC) value of 8.7 mg/g were detected as the threshold level for severe pancreatic iron burden (AUC 70%, p:0.04, AUC 80%, p = 0.002, respectively). Moreover, males were found to have decreased pancreas T2* values compared with the values in females (T2* 19.3 vs. 29.9, p = 0.05). Patients with higher ferritin levels over than 840 ng/mL should be closely monitored for pancreatic iron deposition, and patients with endocrine complications should be assessed in terms of cardiac iron burden.
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Affiliation(s)
- Cihangir Sevimli
- Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasin Yilmaz
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Institute of Health Sciences, Istanbul, Turkey.
| | - Zuhal Bayramoglu
- Department of Pediatric Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Rana Gunoz Comert
- Department of Pediatric Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurdan Gul
- Department of Internal Medicine, Division of Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Memduh Dursun
- Department of Pediatric Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Karakas
- Department of Pediatrics, Division of Hematology and Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Youssry I, Makar S, Abdelkhalek K, Hisham D, Sawires H. Comparing different markers of tubular dysfunction in transfusion-dependent thalassemia patients. Int Urol Nephrol 2021; 54:421-428. [PMID: 34165679 DOI: 10.1007/s11255-021-02914-7] [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: 03/16/2021] [Accepted: 06/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Renal tubular dysfunction was reported in transfusion-dependent thalassemia (TDT) patients and ranges from mild to severe. The objectives of our study were identification of the best marker of early renal tubular dysfunction in TDT patients among the three most commonly used urinary biomarkers, named neutrophil gelatinase-associated lipocalin (NGAL), retinol-binding protein (RBP) and N-acetyl-D-glucosaminidase (NAG) and correlation of these biomarkers with different patient variables. METHODOLOGY Sixty-one TDT patients and another 62 healthy children were enrolled in a cross-sectional study. Morning urine samples were taken for measurement of calcium, phosphorus, creatinine, microalbumin and markers of tubular dysfunction (NGAL, NAG and RBP). Urine NGAL/creatinine (UrNGAL/Cr), urine NAG/creatinine (UrNAG/Cr) and urine RBP/creatinine (UrRBP/Cr) ratios were used for accuracy. Patients were classified into 2 groups: group A, with tubular dysfunction and group b, without tubular dysfunction. RESULTS Group A showed statistically significant higher UrNGAL/Cr (p < 0.001), UrRBP/Cr (p < 0.001) and UrNAG/Cr (p <0.001) than group B. In group A, microalbuminuria was detected only in 7 patients (28%) while it was detected in 12 patients (33.3%) in group B. By using ROC curve analysis, the diagnostic cutoff values for UrNGAL/Cr, UrRBP/Cr and UrNAG/Cr were 3713.38, 1614.85 and 56.56 ng/g, respectively. We found a statistically significant superiority of UrNGAL/Cr over UrRBP/Cr (p < 0.001) and UrRBP/Cr over UrNAG/Cr (p < 0.001). CONCLUSION Evaluation of UrNGAL/Cr, UrRBP/Cr and UrNAG/Cr could early discriminate tubular dysfunction TDT patients from those with normal tubular function. UrNGAL/Cr is more accurate in early detection of tubular dysfunction when compared with the other two biomarkers.
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Affiliation(s)
- Ilham Youssry
- Pediatric Department, Cairo University, Cairo, Egypt
| | - Samuel Makar
- Pediatric Department, Cairo University, Cairo, Egypt
| | | | - Dina Hisham
- Chemical Pathology Department, Cairo University, Cairo, Egypt
| | - Happy Sawires
- Pediatric Department, Cairo University, Cairo, Egypt.
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AttaAllah HR, Mousa SO, Omar IAN. Macular microvascular changes in children with transfusion-dependent beta-thalassemia. Graefes Arch Clin Exp Ophthalmol 2021; 259:3283-3293. [PMID: 34125290 DOI: 10.1007/s00417-021-05275-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/29/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND To investigate the effect of iron overload on macular perfusion among transfusion-dependent thalassemia (TDT) patients using optical coherence tomography angiography (OCTA) METHODS: The study is a prospective observational case-control study. It included 27 eyes from 27 children with transfusion-dependent β-thalassemia and 25 eyes from 25 age-matched controls. All participants were evaluated clinically and with OCTA Avanti RTVue-XR system (Optovue) to assess macular microvascular changes, by measuring vessels density (VDs) and foveal avascular zone (FAZ) area, at both superficial and deep retinal plexuses and at choriocapillaris level. RESULTS Foveal and parafoveal zones were significantly thinner among thalassemia patients, with significantly larger FAZ area at the level of both superficial and deep retinal plexuses when compared with control group. The thalassemia group showed significant lower values compared with the controls regarding whole-image, foveal, and parafoveal deep VD. There were significant negative correlations between serum ferritin and deep (whole image and parafoveal) VD (r = - 0.429, P = 0.026, and r = - 0.452, P = 0.018, respectively). Choriocapillaris VDs (whole image and foveal) showed significant negative correlations with serum ferritin levels (r = - 0.390, P = 0.044 and r = - 0.401, P = 0.038, respectively) CONCLUSIONS: Macular microvascular changes were detected by OCTA examination in patients with TDT, mostly due to iron overload effect, as we selected patients on iron-chelating agent with the least harmful effect on the retina. The most affected layer is the DCP. Changes at the deep layer could be used as a sensitive biomarker for early macular perfusion changes in those patients. TRIAL REGISTRATION Study registration number is UMIN000042657, date of registration: 2020/12/04 (retrospectively registered).
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Bhurani D, Kapoor J, Yadav N, Khushoo V, Agrawal N, Ahmed R, Arora JS, Mehta P. Experience with combination of hydroxyurea and low-dose thalidomide in transfusion-dependent beta thalassemia patients. Ann Hematol 2021; 100:1417-1427. [PMID: 33811502 DOI: 10.1007/s00277-021-04501-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/17/2021] [Indexed: 01/19/2023]
Abstract
Hydroxyurea (HU) and thalidomide have been reported to improve clinical and hematological parameters in transfusion-dependent beta thalassemia (TDT). Therefore, we retrospectively analyzed the combination of HU and thalidomide in 140 transplant ineligible TDT, ≥ 10 years old, visiting our thalassemia clinic between October 2014 and November 2019. Responses were defined as maintenance of hemoglobin ≥9gm/dl without transfusion as complete response (CR) and with at least 50% reduction in transfusion burden as partial response (PR). Patients with less than 50% transfusion burden reduction for consecutive 6 months of therapy were defined as non-responders (NR), and treatment was discontinued thereafter. Primary end point was overall response rate (ORR) at last follow-up. At median follow-up of 22.6 (95% CI 16.4-28.7) months, 76 (57.2%) patients achieved CR and 19 (14.3%) achieved PR, accounting to an ORR of 71.5%. Among responders at last follow-up, a significant increase in the post-treatment hemoglobin (0.88±0.37gm/dl, p<0.0001) and drop in serum ferritin (-1490.5ng/ml, p<0.0001) were observed. Median time to CR was 124 (95% CI 75.3-172.6) days. Median longest continuous CR was 791 (95% CI 662.2-919.7) days. Common toxicities observed were sedation (25%), hyperbilirubinemia {(23.57%, grade 3/4 =17 (12.14%)}, and constipation (22.8%). Nearly three-fourth of the patients has responded with majority having CR. Adverse events are a concern; hence, regular close monitoring is a prerequisite.
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Affiliation(s)
- Dinesh Bhurani
- Department of Hematology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi, 110085, India.
| | - Jyotsna Kapoor
- Department of Hematology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi, 110085, India
| | - Neha Yadav
- Department of Hematology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi, 110085, India
| | - Vishvdeep Khushoo
- Department of Hematology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi, 110085, India
| | - Narendra Agrawal
- Department of Hematology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi, 110085, India
| | - Rayaz Ahmed
- Department of Hematology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi, 110085, India
| | | | - Pallavi Mehta
- Department of Hematology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi, 110085, India
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Sidhu S, Kakkar S, Dewan P, Bansal N, Sobti PC. Adherence to Iron Chelation Therapy and Its Determinants. Int J Hematol Oncol Stem Cell Res 2021; 15:27-34. [PMID: 33613898 PMCID: PMC7885136 DOI: 10.18502/ijhoscr.v15i1.5247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Thalassemia is a chronic disease requiring lifelong treatment. The adherence to regular iron chelation therapy is important to ensure complication-free survival and good quality of life. The study aim to assess the adherence to iron chelation therapy (ICT) in patients with transfusion-dependent thalassemia (TDT), evaluate various causes of non-adherence and study the impact of non-adherence on the prevalence of complications secondary to iron overload. Materials and Methods: Patients with TDT on ICT for > 6 months were enrolled in the study. Hospital records were reviewed for demographic details, iron overload status, treatment details, and the prevalence of complications. A study questionnaire was used to collect information on adherence to ICT, knowledge of patients, and the possible reasons for non-adherence. Results: A total of 215 patients with a mean age of 15.07+7.68 years and an M: F ratio of 2.2:1 were included in the study. Non-adherence to ICT was found in 10.7% of patients. Serum ferritin levels were significantly higher in the non-adherent group (3129.8+1573.2 µg/l) than the adherent population (2013.1+1277.1 µg/l). Cardiac as well as severe liver iron overload was higher in the non-adherent patients. No correlation was found between disease knowledge and adherence to ICT. Difficulties in drug administration and many medicines to be taken daily were statistically significant reasons for non-adherence. There was no difference in the co-morbidities arising due to the iron overload in the two groups. Conclusion: Nearly 11% of patients with TDT were non-adherent to ICT. Non-adherence results in higher iron overload.
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Affiliation(s)
- Sukhmani Sidhu
- Bachelor of Medicine and Bachelor of Surgery Student, Dayanand Medical College, Ludhiana, Punjab, India
| | - Shruti Kakkar
- Department of Pediatrics, Dayanand Medical College, Ludhiana, Punjab, India
| | - Priyanka Dewan
- Department of Pediatrics, Dayanand Medical College, Ludhiana, Punjab, India
| | - Namita Bansal
- Research & Development Unit, Dayanand Medical College, Ludhiana, Punjab, India
| | - Praveen C Sobti
- Guru Teg Bahadur Sahib Charitable Hospital, Ludhiana, Punjab, India
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Darvishi-Khezri H, Kosaryan M, Karami H, Salehifar E, Mahdavi M, Alipour A, Aliasgharian A. Can Use of Silymarin Improve Inflammatory Status in Patients with β-Thalassemia Major? A Crossover, Randomized Controlled Trial. Complement Med Res 2020; 28:123-130. [PMID: 32971524 DOI: 10.1159/000509829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/03/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND In β-thalassemia major (β-TM) patients, iron overload is one of the main causes of inflammation. This study investigated whether use of silymarin could improve inflammatory status in patients with β-TM and iron overload, through a placebo-controlled, crossover study. METHODS Silymarin (140 mg, 3 times a day) or placebo were prescribed to all patients (n = 82) for 12 weeks, and after a 2-week washout period, patients were crossed over to the other group. The efficacy of silymarin was assessed by measuring serum C-reactive protein (CRP) (mg/dL), interleukin (IL)-6 (pg/mL), and IL-10 (pg/mL). RESULTS Sixty-nine patients completed the study. Data analysis showed that compared to the placebo, silymarin could decrease CRP, IL-6, and raise IL-10 significantly (the p values for all variables were <0.001). Cohen's d for CRP adjusted according to the baseline CRP value was -1.72, the 95% confidence interval (CI) -2.12 to -1.33. The adjusted Cohen's d equal to -1.12, 95% CI -1.48 to -0.76, and 0.78, 95% CI 0.43-1.12, were also estimated for IL-6 and IL-10, respectively. CONCLUSION The results of the current study demonstrate that the combination of iron chelation therapy with silymarin can improve inflammatory status in patients with β-TM in the clinical setting.
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Affiliation(s)
- Hadi Darvishi-Khezri
- Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehrnoush Kosaryan
- Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hossein Karami
- Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ebrahim Salehifar
- Phamaceutical Science Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran,
| | - Mohammadreza Mahdavi
- Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Alipour
- Department of Community Medicine, Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Aily Aliasgharian
- Medical Microbiology, Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Tartaglione I, Origa R, Kattamis A, Pfeilstöcker M, Gunes S, Crowe S, Fagan N, Vincenzi B, Ruffo GB. Two-year long safety and efficacy of deferasirox film-coated tablets in patients with thalassemia or lower/intermediate risk MDS: phase 3 results from a subset of patients previously treated with deferasirox in the ECLIPSE study. Exp Hematol Oncol 2020; 9:20. [PMID: 32793403 PMCID: PMC7419189 DOI: 10.1186/s40164-020-00174-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/13/2020] [Indexed: 01/03/2023] Open
Abstract
Background Despite the proven benefits of iron chelation therapy (ICT) in the management of chronic iron overload and related complications, compliance to long-term ICT is challenging. Results from the ECLIPSE study, an open-label, randomized, multicenter, 2-arm, phase 2 study evaluated the safety of deferasirox dispersible tablet and film-coated tablet (FCT) formulations in patients with transfusion-dependent thalassemia (TDT) or very low, low, or intermediate risk myelodysplastic syndrome (MDS) treated over 24 weeks. Methods The aim of the current study (a 2-year, open-label, multicenter, single-arm, phase 3 study) is to evaluate the long-term safety and efficacy of deferasirox FCT in a subset of patients with TDT or lower/intermediate-risk MDS treated for 2 years after the completion of 24 weeks of treatment with deferasirox in the ECLIPSE phase 2 study. Results Of 53 patients enrolled, 34 (64.2%) completed treatment and study. Adverse events (AEs) reported in most patients (~ 70%) were of mild to moderate severity. Headache and diarrhea were the most frequently (> 25%) reported AEs. None of the serious AEs (including 1 death) were considered treatment related. No new safety signal was identified, and long-term safety of deferasirox FCT was consistent with the known safety profile of deferasirox. No major concerns associated with gastrointestinal tolerability, renal safety, or hematological abnormalities (thrombocytopenia/neutropenia) were reported during the 2 years. Patients receiving deferasirox FCT had a treatment compliance (by pill count) of ~ 90% and persistence (continuous use for ≥ 30 days) of > 95%. Reduction in serum ferritin level was almost consistent starting from week 2 across all post-baseline time points (relative reduction: month 6, 19%; month 12, 29%). Conclusions The results from this 2-year interventional study suggest that the recommended dosing of deferasirox FCT, with better tolerability, palatability, and compliance, offers a favorable option of ICT for long-term management of iron overload and associated complications in TDT. Trial registration ClinicalTrials.gov, NCT02720536. Registered 28 March 2016, https://www.clinicaltrials.gov/ct2/show/NCT02720536
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Affiliation(s)
- Immacolata Tartaglione
- Department of Woman, Child and of General and Specialist Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Raffaella Origa
- Ospedale Pediatrico Microcitemico "A.Cao," A.O. "G.Brotzu", Cagliari, Italy
| | - Antonis Kattamis
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | | | - Giovan Battista Ruffo
- U.O.C. Ematologia e Talassemia, A.O. Civico-Di Cristina-Benfratelli, Piazza Nicola Leotta 4, 90127 Palermo, Italy
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Silvilairat S, Charoenkwan P, Saekho S, Tantiworawit A, Srichairatanakool S. Early detection of ventricular dysfunction by tissue Doppler echocardiography related to cardiac iron overload in patients with thalassemia. Int J Cardiovasc Imaging 2020; 37:91-98. [PMID: 32728990 DOI: 10.1007/s10554-020-01949-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/11/2020] [Accepted: 07/20/2020] [Indexed: 01/18/2023]
Abstract
Cardiac T2* MRI is used as a gold standard for cardiac iron quantification in patients with transfusion-dependent thalassemia (TDT). We hypothesized that left ventricular (LV) diastolic dysfunction would reflect the severity of iron overload and can serve as an early detection of cardiac iron deposits. A study was conducted on all patients with TDT. Hemoglobin, serum ferritin and non-transferrin bound iron, together with a complete echocardiography and cardiac T2* MRI, were performed on all patients. Seventy-seven patients with TDT were enrolled (median age 14 years). In the patient group with a mean serum ferritin of > 2500 ng/mL during the past 12 months, there were more patients with severe cardiac iron deposits than in the group with a mean serum ferritin of ≤ 2500 ng/mL. Diastolic dysfunction was absent in all patients with a serum ferritin of < 1000 ng/mL. All patients with cardiac T2* ≤ 20 ms had grade III LV diastolic dysfunction. However, twenty-one percent of patients with cardiac T2* > 20 ms had LV diastolic dysfunction. The differences observed in pulmonary vein atrial reversal duration and mitral A-wave (PVAR-MVA) duration ≥ - 1 ms and an E/E' ratio ≥ 11 were proven to be the associated factors with the cardiac T2* ≤ 20 ms. Increased PVAR-MVA duration and increased E/E' ratio reliably reflected a severe iron overload, according to a cardiac T2* in patients with TDT. LV diastolic dysfunction can occur prior to severe cardiac iron deposition. Tissue Doppler echocardiography has the potential for the early detection of cardiac involvement in patients with TDT .
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Affiliation(s)
- Suchaya Silvilairat
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
| | - Pimlak Charoenkwan
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Suwit Saekho
- Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,Biomedical Engineering Center, Faculty of Engineering, Chiang Mai University, Chiang Mai, Thailand
| | - Adisak Tantiworawit
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Shafie AA, Chhabra IK, Wong JHY, Mohammed NS, Ibrahim HM, Alias H. Health-related quality of life among children with transfusion-dependent thalassemia: A cross-sectional study in Malaysia. Health Qual Life Outcomes 2020; 18:141. [PMID: 32408899 PMCID: PMC7227257 DOI: 10.1186/s12955-020-01381-5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/27/2020] [Indexed: 01/21/2023] Open
Abstract
Background The treatment of children with transfusion-dependent thalassemia (TDT) in Malaysia has progressed since 2005. This study provides an updated health-related quality of life (HRQoL) assessment for children with the disorder and the factors affecting the HRQoL. Methods A cross-sectional HRQoL survey of Malaysian children with TDT was conducted using the PedsQL™ 4.0 Generic Core Scales. Patients with non-transfusion dependent thalassemia and other haemoglobinopathies were excluded. Parent-proxy and self-reported HRQoL scores were obtained using a multi-stage convenient sampling. The relationship between HRQoL scores and demographic factors were tested using association, correlation and regression analysis. Results A total of 368 patients were recruited. The mean (SD) Total Summary Score (TSS) was 80.12(13.87). Predictors for a lower TSS was an increasing age group and the use of dual chelating agents (R2 = 0.057, F (4, 359) = 5.40, p = < 0.001). The mean (SD) Physical Health Summary Score (PHSS) was 82.21 (16.82). Predictors of a higher PHSS score was being male, while predictors of a lower score was an increasing age group and parent-proxy reports(R2 = 0.075, F (5,358) = 5.80, p = < 0.001). The mean (SD) Psychosocial Health Summary Score (PCHS) was 79.39 (14.81). Predictors for a lower PCHS was the use of dual chelating agents(R2 = 0.041, F (1, 362) = 15.60, p = < 0.001). The school functioning score had the lowest mean (SD) score of 69.52(20.92) in the psychosocial dimension. Conclusion The HRQoL of TDT children in Malaysia has improved over the last decade owing to the better access in treatment. However, further effort is needed to improve the school functioning dimension.
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Affiliation(s)
- Asrul Akmal Shafie
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, Minden, 11800, Pulau Pinang, Malaysia. .,Institutional Planning and Strategic Centre, Universiti Sains Malaysia, Minden, 11800, Penang, Malaysia.
| | - Irwinder Kaur Chhabra
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, Minden, 11800, Pulau Pinang, Malaysia.,Pharmacy Department, Sabah Women and Children's Hospital, Ministry of Health Malaysia, Karung Berkunci No.187, 88996, Kota Kinabalu, Sabah, Malaysia
| | - Jacqueline Hui Yi Wong
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, Minden, 11800, Pulau Pinang, Malaysia.,Pharmacy Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586, Kuala Lumpur, Malaysia
| | - Noor Syahireen Mohammed
- Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, Minden, 11800, Pulau Pinang, Malaysia.,Clinical Research Center, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, KM 6 Jalan Langgar, 05460, Kedah Darul Aman, Alor Setar, Malaysia
| | - Hishamshah Mohd Ibrahim
- Tunku Azizah Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Wilayah Persekutuan Kuala Lumpur, Malaysia.,Division of Research and Technical Support, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Hamidah Alias
- Paediatric Haematology and Oncology Unit, Department of Paediatrics, UKM Medical Centre, Faculty of Medicine, The National University of Malaysia, Wilayah Persekutuan Kuala Lumpur, Malaysia
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Shah FT, Sayani F, Trompeter S, Drasar E, Piga A. Challenges of blood transfusions in β-thalassemia. Blood Rev 2019; 37:100588. [PMID: 31324412 DOI: 10.1016/j.blre.2019.100588] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [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: 04/17/2019] [Revised: 06/18/2019] [Accepted: 07/05/2019] [Indexed: 01/28/2023]
Abstract
Patients with β-thalassemia major (BTM) require regular blood transfusions, supported by appropriate iron chelation therapy (ICT), throughout their life. β-thalassemia is a global disease that is most highly prevalent in Southeast Asia, Africa, and Mediterranean countries. However, the global distribution of patients with β-thalassemia is changing due to population migration, and Northern European countries now have significant thalassemia populations. Globally, many patients with BTM have limited access to regular and safe blood transfusions. A lack of voluntary nonremunerated blood donors, poor awareness of thalassemia, a lack of national blood policies, and fragmented blood services contribute to a significant gap between the timely supply of, and demand for, safe blood. In many centers, there is inadequate provision of antigen testing, even for common red cell antigens such as CcEe and Kell. Policies to raise awareness and increase the use of red blood cell antigen testing and requesting of compatible blood in transfusion centers are needed to reduce alloimmunization (the development of antibodies to red blood cell antigens), which limits the effectiveness of transfusions and the potential availability of blood. Patients with BTM are also at risk of transfusion-transmitted infections unless appropriate blood screening and safety practices are in place. Hence, many patients are not transfused or are undertransfused, resulting in decreased health and quality-of-life outcomes. Hemovigilance, leukoreduction, and the ability to thoroughly investigate transfusion reactions are often lacking, especially in resource-poor countries. ICT is essential to prevent cardiac failure and other complications due to iron accumulation. Despite the availability of potentially inexpensive oral ICT, a high proportion of patients suffer complications of iron overload and die each year due to a lack of, or inadequate, ICT. Increased awareness, training, and resources are required to improve and standardize adequate blood transfusion services and ICT among the worldwide population of patients with BTM. ICT needs to be available, affordable, and correctly prescribed. Effective, safe, and affordable new treatments that reduce the blood transfusion burden in patients with β-thalassemia remain an unmet need.
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Affiliation(s)
| | - Farzana Sayani
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Sara Trompeter
- University College London Hospitals, NHS Foundation Trust, London, UK; NHS Blood and Transplant, Bristol, UK.
| | - Emma Drasar
- Whittington Health NHS Trust, London, UK; University College London Hospitals, NHS Foundation Trust, London, UK.
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Patpan N, Banjerdpongchai R, Tantiworawit A, Poofery J, Komonrit P, Fanhchaksai K, Rattanathammethee T, Chai-Adisaksopha C, Rattarittamrong E, Norasetthada L, Charoenkwan P. The Effect of Transfusion-Dependent Thalassemia Patient's Serum on Peripheral Blood Mononuclear Cell Viability. J Cell Death 2019; 12:1179066018823534. [PMID: 30670921 PMCID: PMC6327338 DOI: 10.1177/1179066018823534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/10/2018] [Indexed: 11/23/2022] Open
Abstract
Iron overload is a major complication in transfusion-dependent thalassemia (TDT) patients. Chronic oxidative stress from iron overload may lead to cellular damage and viability. This is a cross-sectional study. Transfusion-dependent thalassemia patients aged ⩾18 years old were enrolled. Transfusion-dependent thalassemia patient’s serum and normal volunteer’s serum were separately incubated with healthy peripheral blood mononuclear cells (PBMCs). The cell viability was measured by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay at 24, 48, and 72 hours. Sixty-nine TDT patients and 22 healthy controls were enrolled. The mean of PBMCs viability after incubation with serum from TDT patients was lower than that with the controls (88.65% vs 103.56% at 24 hours, 78.77% vs 112.04%% at 48 hours, and 71.18% vs 132.16%% at 72 hours, respectively). High serum ferritin level (correlation −0.29, P < .05) and white blood cell (WBC) count negatively affected cell viability (correlation −2.86, P = .05). From multivariate analysis, serum ferritin level is the only significant risk factor that is independently associated with cell viability (correlation −11.42, P < .001). Our findings showed that TDT patient’s serum causes decreased cell viability. Serum ferritin level was a significant independent factor influencing cell viability.
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Affiliation(s)
- Nawapong Patpan
- Division of Hematology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Adisak Tantiworawit
- Division of Hematology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Juthathip Poofery
- Department of Biochemistry, Chiang Mai University, Chiang Mai, Thailand
| | - Phimphan Komonrit
- Department of Biochemistry, Chiang Mai University, Chiang Mai, Thailand
| | - Kanda Fanhchaksai
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Chatree Chai-Adisaksopha
- Division of Hematology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ekarat Rattarittamrong
- Division of Hematology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Lalita Norasetthada
- Division of Hematology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pimlak Charoenkwan
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Abstract
Introduction of MRI techniques for identifying and monitoring tissue iron overload and the current understanding of iron homeostasis in transfusion-dependent (TDT) and non-transfusion-dependent thalassemia have allowed for a more robust administration of iron chelation therapies. The development of safe and efficient oral iron chelators and the insights gained from large-scale prospective studies using these agents have improved iron overload management. A significant reduction in iron toxicity-induced morbidity and mortality and improvements in quality of life were observed in TDT. The appropriate management of tissue-specific iron loading in TDT has been portrayed using evidence-based data obtained from investigational studies.
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Affiliation(s)
- Yesim Aydinok
- Department of Pediatric Hematology and Oncology, Ege University Children's Hospital, Bornova, Izmir 35100, Turkey.
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Yesilipek MA, Karasu G, Kaya Z, Kuskonmaz BB, Uygun V, Dag I, Ozudogru O, Ertem M. A Phase II, Multicenter, Single-Arm Study to Evaluate the Safety and Efficacy of Deferasirox after Hematopoietic Stem Cell Transplantation in Children with β-Thalassemia Major. Biol Blood Marrow Transplant 2018; 24:613-8. [PMID: 29155313 DOI: 10.1016/j.bbmt.2017.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 11/02/2017] [Indexed: 01/30/2023]
Abstract
We conducted a prospective, phase II, multicenter, single-arm study to evaluate the efficacy and safety of deferasirox in patients age >2 to <18 years with β-thalassemia major (TM) who underwent hematopoietic stem cell transplantation (HSCT) and had evidence of iron overload (serum ferritin >1000 µg/L; cardiac MRI T2* <20 ms, or liver iron concentration [LIC; by MRI R2] ≥5 mg/g). Patients received deferasirox at an initial dose of 10 mg/kg/day, with up-titration to a maximum of 20 mg/kg/day. The study continued for 52 weeks and included a total of 27 patients (mean age, 9.1 ± 3.8 years; 70.4% male). One patient (3.7%) was lost to follow-up. The majority of patients (n = 20; 74.1%) were able to achieve the intended dose of 20 mg/kg/day. No deaths occurred. A total of 134 adverse events (AEs) were reported in 25 patients (92.6%) during the study. The majority of patients had grade 1 or 2 AEs, with only 8 patients (29.6%) experiencing grade 3 AEs. Only 10 AEs occurring in 4 patients (14.8%) were suspected to be related to deferasirox (ALT/AST increase, n = 4; urinary tract infection, n = 1). The deferasirox dose had to be adjusted or interrupted for 6 AEs occurring in 4 patients (14.8%). A total of 6 serious AEs occurred in 3 patients (11.1%), none of which were suspected to be related to deferasirox. From baseline to week 52, there were decreases in median concentrations of alanine aminotransferase (ALT), from 30.0 to 17.0 IU/L, and aspartate aminotransferase (AST), from 35.5 to 26.0 IU/L. Median serum creatinine and cystatin C concentrations were similar at baseline and week 52. There was a continuous and significant decrease in median serum ferritin level from 1718.0 µg/L at baseline to 845.3 µg/L following 52 weeks of therapy (P < .001); 9 patients (33.3%) achieved a level of <500 µg/L. There was also a significant decrease in median LIC (from 8.6 to 4.1 mg/g; P < .001) and an increase in median cardiac T2* (from 26.0 to 28.0 ms; P = .520) from baseline to week 52. Our findings indicate that deferasirox treatment at doses up to 20 mg/kg/day reduces the iron burden in children with TM post-HSCT, with a manageable safety profile.
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