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Núñez-Jurado D, Payán-Pernía S, Álvarez-Ríos AI, Jiménez-Jambrina M, Concepcion Pérez-De-Soto I, José Palma-Vallellano A, Zapata-Bautista R, Carlos Hernández-Castellet J, Paz Garrastazul-Sánchez M, Arqueros-Martínez V, Urbano-Ramos MDM, Abdelkader-Maanan M, Raúl García-Lozano J, Delgado-Pecellín C. Neonatal Screening for Sickle Cell Disease in Western Andalusia: Results and Lessons Learnt after 3 Years of Implementation. Am J Perinatol 2024; 41:e893-e900. [PMID: 36580977 DOI: 10.1055/s-0042-1759646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to present the results obtained in the Newborn Screening Program (NSP) for sickle cell disease (SCD) in western Andalusia and the autonomous city of Ceuta in the first 3 years of implementation, and to describe the discrepancies found in the diagnosis of hemoglobinopathies between the screening method and the confirmatory tests. STUDY DESIGN A descriptive and retrospective study was carried out, and the findings obtained in the newborns included in the NSP between November 2018 and December 2021 were analyzed. RESULTS A total of 111,205 samples were screened by high-performance liquid chromatography (HPLC). The birth prevalence of SCD, sickle cell trait, hemoglobin C carriers, and the compound heterozygosity Hb C/β-thalassemia was 1/12,356, 1/467, 1/1,278, and 1/55,602 newborns, respectively. Although there was a correlation between the first-line HPLC screening technique (VARIANTnbs HPLC analyzer, Bio-Rad) and the confirmatory tests in most cases, major discrepancies were found in detecting carriers of G-Philadelphia, D, E, and O-Arab hemoglobin variants, with the former having an incidence of 1/10,110 and the others 1/22,241. The carrier status of Hb G-Philadelphia produced an FAD pattern on the screening method that could be mistaken as Hb D, while Hb O-Arab was identified as an FA5 pattern. Hb D was initially recognized as Hb D in two cases. CONCLUSION An NSP requires at least two different combined methods in order to identify the hemoglobin variant with sufficient certainty. Furthermore, even though software solutions for HPLC suggest a pattern, it must be confirmed with another technique to obtain a correct interpretation of the chromatograms. KEY POINTS · The NSPs are an essential activity in preventive medicine.. · At least two different combined methods are required to correctly identify hemoglobin variants.. · Different variants can produce a similar or identical pattern by a single method..
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Affiliation(s)
- David Núñez-Jurado
- Clinical Biochemistry Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS/CSIC), Seville, Spain
| | - Salvador Payán-Pernía
- Red Blood Cell Disorders Unit, Hematology Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS/CSIC), Seville, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana I Álvarez-Ríos
- Clinical Biochemistry Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS/CSIC), Seville, Spain
| | - Margarita Jiménez-Jambrina
- Red Blood Cell Disorders Unit, Hematology Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS/CSIC), Seville, Spain
| | - Inmaculada Concepcion Pérez-De-Soto
- Red Blood Cell Disorders Unit, Hematology Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS/CSIC), Seville, Spain
| | | | | | | | | | | | | | | | | | - Carmen Delgado-Pecellín
- Clinical Biochemistry Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS/CSIC), Seville, Spain
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Alshahrani NZ, Algethami MR. The effectiveness of hematopoietic stem cell transplantation in treating pediatric sickle cell disease: Systematic review and meta-analysis. Saudi Pharm J 2024; 32:102049. [PMID: 38571765 PMCID: PMC10988128 DOI: 10.1016/j.jsps.2024.102049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
Background Patients with sickle cell disease (SCD) have just one recognized curative therapy option: hematopoietic stem cell transplantation (HSCT), which results in a long-lasting improvement in the clinical phenotype. Here, we assessed the effectiveness of HSCT in treating children with SCD by a systematic review and meta-analysis. Methods Up until January 2024, a comprehensive search was done using Web of Science, CINAHL, Embase, Google Scholar, Cochrane Library, PubMed/Medline, and Embase. Two reviewers worked separately to extract the data, and Newcastle-Ottawa Quality Assessment tool was used to assess the research's quality. The outcomes analyzed were Overall survival (OS), event-free survival (EFS), graft failure (GF) and mortality. Results Nineteen papers satisfied our inclusion requirements and were assessed to be of fair quality. The pooled rate of OS was high (92%; 95% CI: 90.3%-93.5%). Similar finding was detected for EFS (85.8%; 95% CI: 83.7%-87.7%). In the other hand, pooled rates of GF and mortality were 6.9% (95% CI: 5.3%-8.9%) and 7.4% (95% CI: 5%-10.7%), respectively. A significant publication bias was detected for OS, EFS and GF outcomes. Subgroups analysis showed that study design was the major source of heterogeneity. Conclusion Our results show that HSCT is effective and safe, with pooled survival rates above 90%. It is important to assess innovative tactics in light of the alarming GF and mortality rates.
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Affiliation(s)
- Najim Z. Alshahrani
- Department of Family and Community Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Mohammed R. Algethami
- Department of Family and Community Medicine, University of Jeddah, Jeddah, Saudi Arabia
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García-Morin M, Bardón-Cancho EJ, Beléndez C, Dulín E, Blanco-Soto P, Puertas-López C, Prieto-Medina M, Cervera-Bravo Á, Llorente-Otones L, Pérez-Alonso V, San-Román S, Vecilla-Rivelles C, López-Rubio M, Sebastián E, Bellón JM, Cela E. Madrid Newborn Sickle Cell Disease Cohort: clinical outcomes, stroke prevention and survival. Ann Hematol 2024; 103:373-383. [PMID: 37980280 DOI: 10.1007/s00277-023-05539-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/03/2023] [Indexed: 11/20/2023]
Abstract
In May 2003, Madrid established the universal newborn screening (NBS) for sickle cell disease (SCD). However, there are no studies resembling the evolution of a SCD neonate cohort followed according to national guidelines in Spain. The aim of this study is to describe the morbimortality and the stroke prevention programme in patients diagnosed by SCD NBS in Madrid. This is a multicentre, observational, prospective cohort study between 2003 and 2018; 187 patients diagnosed with SCD were included (151 HbSS, 6 HbSβ0, 27 HbSC, 3 HbSβ +), and median follow-up was 5.2 years (0.03-14.9). There were 5 deaths: 2 related to SCD in patients with severe genotype (HbSS/HbSβ0). Overall survival reached 95% and SCD-related survival 96.8%. The most frequent events were fever without focus, vaso-occlusive crises and acute chest syndromes. Eight strokes occurred in 5 patients which led to a 90.7% stroke-free survival in severe genotype patients (first stroke rate, 0.54 per 100 patient-years). Transcranial Doppler (TCD) was performed in 95% of eligible patients; 75% of children with pathological TCD remained stroke-free. Regarding HbSS/HbSβ0 patients, 50.1% received hydroxyurea and 9.5% haematopoietic stem cell transplantation. This study reflects the evolution of Madrid SCD cohort and provides morbimortality data similar to other developed countries.
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Affiliation(s)
- Marina García-Morin
- Pediatric Oncology/Hematology/BMT Unit, Pediatric Department, Facultad de Medicina, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, C/ Maiquez, 9, 28007, Madrid, Spain
- Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Eduardo J Bardón-Cancho
- Pediatric Oncology/Hematology/BMT Unit, Pediatric Department, Facultad de Medicina, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, C/ Maiquez, 9, 28007, Madrid, Spain.
- Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Cristina Beléndez
- Pediatric Oncology/Hematology/BMT Unit, Pediatric Department, Facultad de Medicina, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, C/ Maiquez, 9, 28007, Madrid, Spain
- Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Dulín
- Newborn Screening Laboratory, Hospital General Universitario Gregorio Marañón, C/Maiquez, 9, 28007, Madrid, Spain
| | - Paula Blanco-Soto
- Newborn Screening Laboratory, Hospital General Universitario Gregorio Marañón, C/Maiquez, 9, 28007, Madrid, Spain
| | - Carolina Puertas-López
- Newborn Screening Laboratory, Hospital General Universitario Gregorio Marañón, C/Maiquez, 9, 28007, Madrid, Spain
| | - Mar Prieto-Medina
- Nursery, Sickle Cell Disease Newborn Screening, Pediatric Department, Pediatric Oncology/Hematology/BMT Unit, Madrid, Spain
| | - Áurea Cervera-Bravo
- Hematology Unit, Pediatric Department, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | - Lucía Llorente-Otones
- Hematology Unit, Pediatric Department, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Vanesa Pérez-Alonso
- Pediatric Oncology and Hematology Unit, Pediatric Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Sonsoles San-Román
- Pediatric Oncology and Hematology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Cruz Vecilla-Rivelles
- Hematology Unit, Pediatric Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Montserrat López-Rubio
- Hematology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Elena Sebastián
- Pediatric Oncology and Hematology Department, Hospital Infantil Niño Jesús, Madrid, Spain
| | - José M Bellón
- Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Elena Cela
- Pediatric Oncology/Hematology/BMT Unit, Pediatric Department, Facultad de Medicina, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, C/ Maiquez, 9, 28007, Madrid, Spain
- Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
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Colombatti R, Hegemann I, Medici M, Birkegård C. Systematic Literature Review Shows Gaps in Data on Global Prevalence and Birth Prevalence of Sickle Cell Disease and Sickle Cell Trait: Call for Action to Scale Up and Harmonize Data Collection. J Clin Med 2023; 12:5538. [PMID: 37685604 PMCID: PMC10488271 DOI: 10.3390/jcm12175538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited monogenic disorder with high prevalence throughout sub-Saharan Africa, the Mediterranean basin, the Middle East, and India. Sources of SCD epidemiology remain scarce and fragmented. A systematic literature review (SLR) to identify peer-reviewed studies on SCD epidemiology was performed, with a search of bibliographic databases and key conference proceedings from 1 January 2010 to 25 March 2022 (congress abstracts after 2018). The SLR followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Meta-analyses, using a binomial normal random-effects model, were performed to estimate global and regional prevalence and birth prevalence. Of 1770 journal articles and 468 abstracts screened, 115 publications met the inclusion criteria. Prevalence was highest in Africa (~800/100,000), followed by the Middle East (~200/100,000) and India (~100/100,000), in contrast to ~30/100,000 in Europe. Birth prevalence was highest in Africa (~1000/100,000) and lowest in North America (~50/100,000) and Europe (~30/100,000). This SLR confirmed that sub-Saharan and North-East Africa, India, the Middle East, and the Caribbean islands are global SCD hotspots. Publications including mortality data were sparse, and no conclusions could be drawn about mortality. The identified data were limited due to gaps in the published literature for large parts of the world population; the inconsistent reporting of SCD genotypes, diagnostic criteria, and settings; and a sparsity of peer-reviewed publications from countries with assumed high prevalence. This SLR demonstrated a lack of systematic knowledge and a need to provide uniform data collection on SCD prevalence and mortality.
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Affiliation(s)
- Raffaella Colombatti
- Clinic of Pediatric Hematology Oncology, Department of Child and Maternal Health, Azienda Ospedaliera, University of Padova, 35122 Padua, Italy
| | | | - Morten Medici
- Novo Nordisk A/S, 2860 Søborg, Denmark; (M.M.); (C.B.)
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Sickle Cell Disease Newborn Screening—An Audit of a Twin Island State Pilot Program. Int J Neonatal Screen 2023; 9:ijns9010014. [PMID: 36975852 PMCID: PMC10052052 DOI: 10.3390/ijns9010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
The prevalence of Sickle Cell Disease (SCD) within the Caribbean region remains second only to that of West Africa. The Newborn Screening (NBS) Program in Antigua and Barbuda remains heavily dependent on grants, therefore ultimately facing sustainability challenges. Early intervention and implementation of preventative measures post-NBS result in significant improvements in morbidity, quality of life, and survival. This audit reviewed the pilot SCD NBS Program in Antigua and Barbuda from September 2020 to December 2021. A conclusive result was received by 99% of babies eligible for screening, 84.3% of which were HbFA, whilst 9.6% and 4.6% were HbFAS and HbFAC, respectively. This was comparable to other Caribbean countries. Sickle Cell Disease was noted in 0.5% of babies screened, which translates to 1 in 222 live births. Eighty-two percent of mothers were aware of their sickle cell status, compared to 3% of fathers. The importance of instituting a quality improvement team post the initiation of a screening program and the need for a robust public education program have been demonstrated by this audit.
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Benítez-Carabante MI, Beléndez C, González-Vicent M, Alonso L, Uría-Oficialdegui ML, Torrent M, Pérez-Hurtado JM, Fuster JL, Cela E, Díaz-de-Heredia C. Matched sibling donor stem cell transplantation for sickle cell disease: Results from the Spanish group for bone marrow transplantation in children. Eur J Haematol 2021; 106:408-416. [PMID: 33296531 DOI: 10.1111/ejh.13566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The prevalence of sickle cell disease (SCD) in Spain is markedly inferior compared with other European and Mediterranean countries. However, the diagnosis of new patients with SCD is expected to increase. In this multicenter retrospective study, we analyze the hematopoietic stem cell transplantation (HSCT) results obtained in Spain. METHODS Forty-five patients who underwent a matched sibling donor (MSD) HSCT between 1999 and 2018 were included. Primary endpoint was event-free survival (EFS), and secondary endpoints included acute and chronic graft-versus-host disease (GvHD) and overall survival (OS). RESULTS Bone marrow was the most frequent stem cell source (93.3%). Most patients received a conditioning regimen based on busulfan and cyclophosphamide (69%). Cumulative incidence of grade III-IV acute GvHD and chronic GvHD was 6.8% (95% CI: 2.3%-20.1%) and 5.4% (95% CI: 1.38%-19.9%), respectively. EFS and overall survival (OS) at 3 years post-HSCT were 89.4% (95% CI: 73.9%-95.9%) and 92.1% (95% CI: 77.2%-97.4%), respectively. All patients aged ≤ 5 presented 100% EFS and OS. CONCLUSIONS An early referral to HSCT centers should be proposed early in life, before severe complications occur. MSD HSCT should be considered a curative option for all patients aged ≤ 5 years and for older pediatric patients who present complications derived from the disease.
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Affiliation(s)
- María Isabel Benítez-Carabante
- Department of Pediatric Hematology and Oncology, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Cristina Beléndez
- Department of Pediatric Hematology and Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marta González-Vicent
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Laura Alonso
- Department of Pediatric Hematology and Oncology, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - María Luz Uría-Oficialdegui
- Department of Pediatric Hematology and Oncology, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Monserrat Torrent
- Department of Pediatric Hematology and Oncology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | | | - José Luis Fuster
- Department of Pediatric Hematology and Oncology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Elena Cela
- Department of Pediatric Hematology and Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Díaz-de-Heredia
- Department of Pediatric Hematology and Oncology, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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