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Daar S, Al-Naamani K, De Sanctis V, Al Rahbi S, Al Zadjali S, Khan H, Panjwani V, Al-Khabori M. Mortality and complications in Omani patients with beta-thalassemia major: a long-term follow-up study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023191. [PMID: 37539594 PMCID: PMC10440768 DOI: 10.23750/abm.v94i5.14856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 06/07/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND AIM Beta thalassemia major (β-TM) is a genetic blood disorder requiring lifelong blood transfusions. The resulting iron overload damages multiple organs, particularly the heart and endocrine organs. This study aimed to describe and assess the predictors of survival and complications in Omani patients with β-TM. Methods: All β-TM patients registered in the day care of Sultan Qaboos University Hospital were included in this retrospective study. Results: There were 187 patients with β-TM with a median follow-up of 24.9 years. The median ages at diagnosis and the start of chelation were 0.7 and 4.8 years, respectively. The following complications developed at different time points [Median (age in years), Complication Free Probability at 20 years]: Death (20.0 years;85%), hypogonadism (15.9 years;50%), insulin-dependent or non-insulin dependent diabetes (20.0 years;88%), cardiac complications (20.3 years;91%), osteoporosis (20.7 years;96%), hypothyroidism (25.7 years;97%), liver complications (7.3 years;54%). The number of complications predicted death (P = 0.0038). Those born after 1980 had a lower risk of death (P = 0.005), hypogonadism (P = < 0.0001), and cardiac complications (P = 0.004). Higher serum ferritin at the start of chelation was associated with the development of diabetes (P = < 0. 001). Conclusions: This long-term study shows complications development at different ages, and the number of complications is associated with survival. Later birth cohorts had a lower risk of death, hypogonadism, and cardiac complications. There was a persistent negative impact of delay in the start of iron chelation that is present even after a long follow-up. (www.actabiomedica.it).
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Malagù M, Marchini F, Fiorio A, Sirugo P, Clò S, Mari E, Gamberini MR, Rapezzi C, Bertini M. Atrial Fibrillation in β-Thalassemia: Overview of Mechanism, Significance and Clinical Management. BIOLOGY 2022; 11:biology11010148. [PMID: 35053146 PMCID: PMC8772694 DOI: 10.3390/biology11010148] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 05/05/2023]
Abstract
Thalassemia is an inherited blood disorder with worldwide distribution. Transfusion and chelation therapy have radically improved the prognosis of β-thalassemic patients in the developed world, but this has led to the development of new chronic cardiac complications like atrial fibrillation (AF). Prevalence of AF in patients with β-thalassemia is higher than in the general population, ranging from 2 to 33%. Studies are lacking, and the little evidence available comes from a small number of observational studies. The pathophysiology is not well understood but, while iron overload seems to be the principal mechanism, AF could develop even in the absence of iron deposition. Furthermore, the clinical presentation is mainly paroxysmal, and patients are highly symptomatic. The underlying disease, the pathophysiology, and the clinical presentation require a different management of AF in β-thalassemia than in the general population. Rhythm control should be preferred over rate control, and the most important antiarrhythmic therapy is represented by chelation drugs. Thromboembolic risk is high, but the available risk scores are not validated in β-thalassemia, and the choice of anticoagulation therapy should be considered early. The main purpose of this review is to summarize the actual knowledge about AF in β-thalassemia, with a specific focus on the clinical management of these complex patients.
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Affiliation(s)
- Michele Malagù
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
- Correspondence: ; Tel.: +39-532-236269
| | - Federico Marchini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
| | - Alessio Fiorio
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
| | - Paolo Sirugo
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
| | - Stefano Clò
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
| | - Elisa Mari
- Day Hospital Thalassemia and Hemoglobinopathies, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (E.M.); (M.R.G.)
| | - Maria Rita Gamberini
- Day Hospital Thalassemia and Hemoglobinopathies, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (E.M.); (M.R.G.)
| | - Claudio Rapezzi
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
| | - Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
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Shafie AA, Wong JHY, Ibrahim HM, Mohammed NS, Chhabra IK. Economic burden in the management of transfusion-dependent thalassaemia patients in Malaysia from a societal perspective. Orphanet J Rare Dis 2021; 16:157. [PMID: 33827621 PMCID: PMC8028190 DOI: 10.1186/s13023-021-01791-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transfusion-dependent thalassaemia (TDT) is a hereditary blood disorder in which blood transfusion is the mainstay treatment to prolong survival and improve quality of life. Patients with this disease require blood transfusion at more than 100 ml/kg annually and iron-chelating therapy (ICT) to prevent iron overload (IOL) complications. There are substantial numbers of TDT patients in Malaysia, but limited data are available regarding the economic burden associated with this disease. The purpose of this study was to determine the lifetime cost of TDT from a societal perspective and identify potential factors increasing patient and family expenditures among thalassaemia populations. METHODS The total lifetime cost per TDT patient (TC1) is the sum of lifetime healthcare cost (TC2) and lifetime patient and family healthcare expenditure (TC3). TC2 was simulated using the Markov model, taking into account all costs subsidized by the government, and TC3 was estimated through a cross-sectional health survey approach. A survey was performed using a two-stage sampling method in 13 thalassaemia centres covering all regions in Malaysia. RESULTS A TDT patient is expected to incur TC2 of USD 561,208. ICT was the main driver of cost and accounted for 56.9% of the total cost followed by blood transfusion cost at 13.1%. TC3 was estimated to be USD 45,458. Therefore, the estimated TC1 of a TDT patient was USD 606,665. Sensitivity analyses showed that if all patients were prescribed oral ICT deferasirox for their lifetime, the total healthcare cost would increase by approximately 65%. Frequency of visits to health facilities for blood transfusion/routine monitoring and patients who were prescribed desferrioxamine were observed to be factors affecting patient and family monthly expenses. CONCLUSION The lifetime cost per TDT patient was USD 606,665, and this result may be useful for national health allocation planning. An estimation of the economic burden will provide additional information to decision makers on implementing prevention interventions to reduce the number of new births and medical service reimbursement.
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Affiliation(s)
- Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia.
| | - Jacqueline Hui Yi Wong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia.,Pharmacy Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Hishamshah Mohd Ibrahim
- Division of Research and Technical Support, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Noor Syahireen Mohammed
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia.,Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Kedah Darul Aman, Alor Setar, Malaysia
| | - Irwinder Kaur Chhabra
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia
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Moghimbeygi M, Alavian SM. Eradication of hepatitis C virus infection in thalassemia patients in Iran using various treatment strategies. J Virus Erad 2020; 6:100006. [PMID: 33251024 PMCID: PMC7646675 DOI: 10.1016/j.jve.2020.100006] [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: 04/29/2019] [Revised: 11/10/2019] [Accepted: 07/27/2020] [Indexed: 11/29/2022] Open
Abstract
Background Chronic hepatitis C virus (HCV) infection is considered as one of the leading causes of liver disease in thalassemic patients in Iran. Over 40% of the mortality in these patients is related to HCV. Objectives The present study aimed at estimating HCV prevalence in thalassemic patients in Iran and to determine the number of infections until eradication is achieved. Methods A meta-analysis approach was used to estimate the number of HCV-infected thalassemic patients in the country. The prevalence rate was measured using a modeling approach to predict the number of cases until eradication using several scenarios in terms of testing and treatment, in particular the use of direct acting antiviral drugs (DAAs). Results With the advent of DAAs with a high rate of treatment success, HCV could be eradicated earlier than originally thought among this group of patients. Based on previous predictions the number of HCV-infected thalassemic patients would have been below 66 by 2020. However, according to our predictions, the number will be less than 10 when using DAAs. Conclusion We believe that HCV eradication can be achieved in thalassemic patients with an increased life expectancy by funding DAA-based new treatment strategies. This has been exemplified in Alborz, Lorestan, and South Khorasan provinces with HCV eradication in this group of patients.
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Affiliation(s)
- Meisam Moghimbeygi
- Department of Mathematics, Faculty of Mathematics and Computer Science, Kharazmi University, Tehran, Iran
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Kattamis A, Forni GL, Aydinok Y, Viprakasit V. Changing patterns in the epidemiology of β-thalassemia. Eur J Haematol 2020; 105:692-703. [PMID: 32886826 PMCID: PMC7692954 DOI: 10.1111/ejh.13512] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 01/19/2023]
Abstract
β‐thalassemia major is an inherited hemoglobinopathy that requires lifelong red blood cell transfusions and iron chelation therapy to prevent complications due to iron overload. Traditionally, β‐thalassemia has been more common in certain regions of the world such as the Mediterranean, Middle East, and Southeast Asia. However, the prevalence of β‐thalassemia is increasing in other regions, including Northern Europe and North America, primarily due to migration. This review summarizes the available data on the changing incidence and prevalence of β‐thalassemia as well as factors influencing disease frequency. The data suggest that the epidemiology of β‐thalassemia is changing: Migration has increased the prevalence of the disease in regions traditionally believed to have a low prevalence, while, at the same time, prevention and screening programs in endemic regions have reduced the number of affected individuals. Various approaches to prevention and screening have been used. Region‐specific prevention and treatment programs, customized to align with local healthcare resources and cultural values, have been effective in identifying patients and carriers and providing information and care. Significant challenges remain in universally implementing these programs.
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Affiliation(s)
- Antonis Kattamis
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Gian Luca Forni
- Centro della Microcitemia e Anemie Congenite e del Dismetabolismo del Ferro, Ospedale Galliera, Genoa, Italy
| | - Yesim Aydinok
- Department of Pediatric Hematology and Oncology, Ege University Hospital, Izmir, Turkey
| | - Vip Viprakasit
- Department of Pediatrics & Thalassemia Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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De Sanctis V, Soliman AT, El-Hakim I, Christou S, Mariannis D, Karimi M, Ladis V, Kattamis A, Daar S, Yassin M, Canatan D, Galati MC, Raiola G, Campisi S, Kakkar S, Kaleva V, Saki F, Ellinides A, Pikis G, Christodoulides C, Abdulla M, Di Maio S, Theodoridis C, Elsedfy H, Kattamis C. Marital status and paternity in patients with Transfusion- Dependent Thalassemia (TDT) and Non Transfusion-Dependent Thalassemia (NTDT): an ICET - A survey in different countries. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:225-237. [PMID: 31580308 PMCID: PMC7233736 DOI: 10.23750/abm.v90i3.8586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND More than five decades ago, thalassemia major (TDT) was fatal in the first decade of life. Survival and quality of life have improved progressively thanks to the implementation of a significant advance in diagnostic and therapeutic methods, consisting mainly of a frequent transfusion program combined with intensive chelation therapy. Improvement also includes imaging methods used to measure liver and cardiac iron overload. Improved survival has led to a growing number of adults requiring specialised care and counselling for specific life events, such as sexual maturity and acquisition of a family. AIMS OF THE STUDY The main aim is to present the results of a survey on the marital and paternity status in a large population of adult males with TDT and NTDT living in countries with a high prevalence of thalassemia and a review of current literature using a systematic search for published studies. RESULTS Ten out of 16 Thalassemia Centres (62.5%) of the ICET-A Network, treating a total of 966 male patients, aged above 18 years with β- thalassemias (738 TDT and 228 NTDT), participated in the study. Of the 966 patients, 240 (24.8%) were married or lived with partners, and 726 (75.2%) unmarried. The mean age at marriage was 29.7 ± 0.3 years. Of 240 patients, 184 (76.6%) had children within the first two years of marriage (2.1 ± 0.1 years, median 2 years, range 1.8 - 2.3 years). The average number of children was 1.32 ± 0.06 (1.27 ± 0.07 in TDT patients and 1.47 ± 0.15 in NTDT patients; p: >0.05). Whatever the modality of conception, 184 patients (76.6%) had one or two children and 1 NTDT patient had 6 children. Nine (4.8%) births were twins. Of 184 patients, 150 (81.5%) had natural conception, 23 (12.5%) required induction of spermatogenesis with gonadotropins (hCG and hMG), 8 (4.3%) needed intracytoplasmic sperm injection (ICSI) and 3 adopted a child. 39 patients with TDT and NTDT asked for medical help as they were unable to father naturally: 7 TDT patients (17.9%) were azoospermic, 17 (37.7%) [13 with TDT and 4 with NTDT] had dysspermia and 15 (33.3%) [13 with TDT and 2 with NTDT] had other "general medical and non-medical conditions". CONCLUSIONS Our study provides detailed information in a novel area where there are few contemporary data. Understanding the aspects of male reproductive health is important for physicians involved in the care of men with thalassemias to convey the message that prospects for fatherhood are potentially good due to progressive improvements in treatment regimens and supportive care.
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KOSARYAN M, KARAMI H, DARVISHI-KHEZRI H, AKBARZADEH R, ALIASGHARIAN A, BROMAND K. Treatment Status of Patients with B-Thalassemia Major in Northern Iran: Thalassemia Registry System. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:1335-1345. [PMID: 31497556 PMCID: PMC6708530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Electronic registry system of beta-thalassemia patients was run by Thalassemia Research Center (TRC) in 2017. The aim of the current study was presentation of therapeutic status in these patients at Mazandaran Province, Iran. METHODS Therapeutic status variables including: Name of cities and hospitals, age and sex of patients, dependent and non-transfusion-dependent, starting age of the blood transfusion and iron-chelating agents, blood group and Rh, washed blood transfusion, abnormal antibody, transfusion reactions, mean hemoglobin during the last 3 months, type of iron chelators, iron chelators dosage, serum ferritin, and the use of hydroxyurea. RESULTS Overall, 1831 patients were registered [891 male (48.7%)]. Mean age of patients was 30±9.7 yr. Average of hemoglobin levels for female and male were 9.1±5.1 and 9.4±6.3 gr/dl, respectively. Seventy-six percent of transfusion-dependent patients (1385) have received iso-group PRBC (packed red blood cells), after crossmatch. The most common blood group among patient was type O-positive (35.7%). Monotherapy with desferrioxamine was most type of used iron-chelating agent in these patients (47.2%). Mean of ferritin was 3300±7800 (ng/ml). Twenty-eight percent of patients (484) have received hydroxyurea; proportion of male and female was approximately equal. T2 weighted magnetic resonance imaging (MRIT2*) was measured in 62.2% of patients. Moderate and severe hepatosiderosis was 10.1% and 2.9%, respectively. Patients with moderate and severe cardiac siderosis were 11% and 5%, respectively. CONCLUSION Registry findings are valuable for treatment management and ensuring patients medications. It will also provide accessibility to various levels of patients' information for health care managers and experts to help them make appropriate decisions.
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Affiliation(s)
- Mehrnoush KOSARYAN
- Department of Pediatric, Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hossein KARAMI
- Department of Pediatric, Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran,Corresponding Author:
| | - Hadi DARVISHI-KHEZRI
- Student Research Committee, Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rosetta AKBARZADEH
- Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Aily ALIASGHARIAN
- Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Khadijeh BROMAND
- Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Faraon R, Daraghmah M, Samarah F, Srour MA. Molecular characterization of β-thalassemia intermedia in the West Bank, Palestine. BMC HEMATOLOGY 2019; 19:4. [PMID: 30820323 PMCID: PMC6380065 DOI: 10.1186/s12878-019-0135-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 02/07/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND We aimed to investigate the molecular basis of β-Thalassemia intermedia (TI) in the West Bank region and its management practices. METHODS This was a case series multi-center study and included 51 cases of TI. DNA sequencing was used to analyze β-globin gene mutations. Common α-globin gene mutations were screened by Gap-PCR (-α3.7, -α4.2, --MED, αααanti3.7) or DNA sequencing (α2-IVS II 5 nt del). XmnI -158 C > T polymorphisms of Gγ-globin gene was determined by RFLP-PCR. RESULTS Seven β-globin gene mutations were observed, namely IVS-I -6 C > T, IVS-I-110 G > A, IVS-II-1 G > A, IVS-I-1 G > A, Codon 37 Trp > Stop, beta - 101 and IVS-II-848 C > A. Ten genotypes were observed. Homozygosity for IVS-I-6 accounted for the majority of TI cases with a frequency of 74.5%. The second common β-globin gene genotype was homozygote IVS-I-110 G > A (5.8%) and homozygote IVS-II-1 G > A (5.8%). The remaining seven genotypes were each detected in about 2% of patients. α-Thalassemia mutations were seen in five patients (9.8%), and included (-α3.7, αααanti3.7 and α2-IVSII-5 nt del). XmnI polymorphism was observed in four patients (7.8%), three homozygotes and one heterozygote. CONCLUSIONS Homozygosity for the mild β-globin gene IVS-I-6 allele was the major contributing factor for the TI phenotype among the study subjects. The role of XmnI SNP and α-thalassemia mutations in ameliorating the TI phenotype was observed in few patients for each factor. The beta - 101 C > T mutation was diagnosed in one patient in homozygote state for the first time in Palestine.
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Affiliation(s)
- Rashail Faraon
- Department of Medical Laboratory Sciences, Al-Quds University, East Jerusalem, Palestine
| | - Mahmoud Daraghmah
- Palestine Thalassemia Patients’ Friends Society, Al-Bireh, Palestine
| | - Fekri Samarah
- Department of Medical Laboratory Sciences, Arab-American University, Jenin, Palestine
| | - Mahmoud A. Srour
- Department of Medical Laboratory Sciences, Al-Quds University, East Jerusalem, Palestine
- Department of Biology & Biochemistry, Birzeit University, P.O. Box 14, Birzeit, Palestine
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Ansari-Moghaddam A, Adineh HA, Zareban I, Mohammadi M, Maghsoodlu M. The survival rate of patients with beta-thalassemia major and intermedia and its trends in recent years in Iran. Epidemiol Health 2018; 40:e2018048. [PMID: 30336663 PMCID: PMC6335498 DOI: 10.4178/epih.e2018048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/03/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Thalassemia is a common genetic disease in Iran, especially in the north and south of Iran. The present study sought to determine the survival rate of patients with thalassemia in highly endemic regions of Iran and its variation in patients born before and after 1971. METHODS The present historical cohort study extracted data from the health records of patients with beta-thalassemia major, beta-thalassemia intermedia, and sickle beta-thalassemia who had presented to thalassemia treatment centers in the past years. The collected data were analyzed using the Kaplan-Meier test, the log-rank test, and the chi-square test. RESULTS Of the total of 5,491 medical records (2,647 men and 2,634 women; mean age, 23.81±11.32 years), 3,936 belonged to patients with beta-thalassemia major, and 999 and 89 to patients with beta-thalassemia intermedia and sickle beta-thalassemia, respectively. In 467 cases, the type of thalassemia was not clear. The cumulative survival rate was calculated as 0.92, 0.83, 0.74, and 0.51 by ages 25, 35, 45, and 55, respectively. The hazard ratio of death was 4.22 (p<0.05) for beta-thalassemia major and 0.77 for beta-thalassemia intermedia (p=0.70). It was calculated as 1.45 for men patients and as 3.82 for single patients. CONCLUSIONS The present study showed relatively high survival rates in patients with thalassemia. The survival of patients was unfavorable in poorer regions (Zahedan and Iranshahr). Factors including women gender, a higher level of education, being married, and living in metropolises decreased the risk of death at younger ages and improved survival.
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Affiliation(s)
| | - Hossein Ali Adineh
- Department of Epidemiology and Biostatistics, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Iraj Zareban
- Department of Health Education, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mehdi Mohammadi
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Bakhshi E, Ali Akbari Khoei R, Azarkeivan A, Kooshesh M, Biglarian A. Survival analysis of thalassemia major patients using Cox, Gompertz proportional hazard and Weibull accelerated failure time models. Med J Islam Repub Iran 2017; 31:97. [PMID: 29951398 PMCID: PMC6014765 DOI: 10.14196/mjiri.31.97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Indexed: 11/20/2022] Open
Abstract
Background: Thalassemia major (TM) is a severe disease and the most common anemia worldwide. The survival time of the disease and its risk factors are of importance for physicians. The present study was conducted to apply the semi-parametric Cox PH model and use parametric proportional hazards (PH) and accelerated failure time (AFT) models to identify the risk factors related to survival of TM patients. Methods: The data of this historical cohort study (296 patients with TM) were collected during 1994 and 2013 in Zafar Clinic in Tehran. Gompertz PH and Weibull AFT models were used for survival analysis (SA) of these patients. Data analysis was performed using R3.2.2 software. Results: 153 (51.7%) of patients were female; the mean (±SD) age of the patients was 29.11 (±0.47) years. One-year survival rate for males and females was 0.963±0.007 and 0.973±0.013, respectively; and 3-year survival rate for males and females was 0.711±0.057 and 0.733±0.114, respectively. In the Gompertz model, birthplace and age at onset of the disease were significant factors (p= 0.035, and p= 0.005) in survival time. Also, in the Weibull model, birth place and age at onset of the disease were significant factors (p= 0.013, and p= 0.008) in survival time. The Akaike Information Criterion (AIC) for Weibull model was 158.51, which was lower than other parametric models. Conclusion: According to the results, the Weibull AFT model was found to be a better model for identifying the risk factors related to survival of patients with TM disease. Informing parents, especially mothers and paying attention to blood screening for early diagnosis may increase the survival rate of patients.
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Affiliation(s)
- Enayatollah Bakhshi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Reza Ali Akbari Khoei
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Azita Azarkeivan
- Pediatric Hematology Oncology, Iranian Blood Transfusion Organization (IBTO) – High Institute for Research and Education in Transfusion Medicine, Thalassemia Clinic, Tehran, Iran
| | | | - Akbar Biglarian
- Department of Biostatistics, Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Hassanzadeh J, Mirahmadizadeh A, Karimi M, Veisani Y, Rezaeian S. Trends in 5-, 10-, 20-, and 30-year survival rates of beta-thalassemia patients in Southern Iran, 1995-2016: A retrospective cohort study. J Public Health Res 2017; 6:1001. [PMID: 29291192 PMCID: PMC5737000 DOI: 10.4081/jphr.2017.1001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 05/17/2017] [Accepted: 10/17/2017] [Indexed: 02/08/2023] Open
Abstract
Background: There is currently lack of knowledge about survival trend analysis of thalassemia patients. Therefore, the aim of the present study was to assess 5-, 10-, 20-, and 30-year survival of thalassemia patients over a 20-year time period. Methods: In this retrospective cohort study, we analysed the data of 982 beta-thalassemia patients in Iran. Birth cohort and traditional cohort analyses were used to obtain the 5-, 10-, 20-, and 30-year survival rates in various time intervals between 1995 and 2016. Results: Five and 10-year survival rates remained unchanged since 1995-2016. Overall, 20- and 30-year survival rates were lower in younger birth cohorts than older ones. A declining trend was found in 20-year survival rate from 1995 to 2000 for all and also for thalassemia major patients, but was stable from 2001 to 2016. In addition, there was a declining trend in 30-year survival rate from 1995 to 2008 for all and also for thalassemia major patients, but was an increased trend from 2009 to 2016. Conclusion: Over the past two decades and in recent birth cohorts, the 20- and 30-year survival rates has declined. In other words, declining survival trends in the birth cohorts may be associated with some different causes of mortality such as exposure to the toxic effects of iron over time and the occurrence of diseaserelated mortality.
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Affiliation(s)
- Jafar Hassanzadeh
- Research Centre for Health Sciences, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences
| | - Alireza Mirahmadizadeh
- Department of Epidemiology, School of Health, Non- Communicable Diseases Research Center, Shiraz University of Medical Sciences
| | - Mehran Karimi
- Hematology Research Center, Shiraz University of Medical Sciences
| | - Yousef Veisani
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences
| | - Shahab Rezaeian
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah.,Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Iran
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Rezaeian S. Poor quality of life as a predictor of survival among thalassemia patients in Iran. Epidemiol Health 2017; 39:e2017013. [PMID: 28395398 PMCID: PMC5434223 DOI: 10.4178/epih.e2017013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/12/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Shahab Rezaeian
- Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
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Vitrano A, Calvaruso G, Lai E, Colletta G, Quota A, Gerardi C, Concetta Rigoli L, Pitrolo L, Cuccia L, Gagliardotto F, Filosa A, Caruso V, Argento C, Campisi S, Rizzo M, Prossomariti L, Fidone C, Fustaneo M, Di Maggio R, Maggio A. The era of comparable life expectancy between thalassaemia major and intermedia: Is it time to revisit the major-intermedia dichotomy? Br J Haematol 2016; 176:124-130. [PMID: 27748513 DOI: 10.1111/bjh.14381] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/24/2016] [Accepted: 07/26/2016] [Indexed: 01/19/2023]
Abstract
In the last few decades, the life expectancy of regularly transfused β-thalassaemia major (TM) patients has dramatically improved following the introduction of safe transfusion practices, iron chelation therapy, aggressive treatment of infections and improved management of cardiac complications. How such changes, especially those attributed to the introduction of iron chelation therapy, improved the survival of TM patients to approach those with β-thalassaemia intermedia (TI) remains unknown. Three hundred and seventy-nine patients with TM (n = 284, dead 40) and TI (n = 95, dead 13) were followed retrospectively since birth until 30 June 2015 or death. Kaplan-Meir curves showed statistically significant differences in TM and TI survival (P < 0·0001) before the introduction of iron chelation in 1965, which were no longer apparent after that date (P = 0·086), reducing the Hazard Ratio of death in TM compared to TI from 6·8 [95% confidence interval (CI) 2·6-17·5] before 1965 to 2·8 (95% CI 0·8-9·2). These findings suggest that, in the era of iron chelation therapy and improved survival for TM, the major-intermedia dichotomy needs to be revisited alongside future directions in general management and prevention for both conditions.
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Affiliation(s)
- Angela Vitrano
- Campus of Haematology Franco e Piera Cutino - A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Giuseppina Calvaruso
- Campus of Haematology Franco e Piera Cutino - A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Eliana Lai
- Ospedale microcitemico, Centro Talassemici Adulti, University of Cagliari, Cagliari, Italy
| | - Grazia Colletta
- Azienda Ospedaliera Università Policlinico "Vittorio Emanuele - P.O. Ferrarotto", Catania, Italy
| | | | - Calogera Gerardi
- U.O.S. di Talassemia P.O. "Giovanni Paolo II" Sciacca, Sciacca, Italy
| | | | - Lorella Pitrolo
- Campus of Haematology Franco e Piera Cutino - A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Liana Cuccia
- U.O.C. 7a Pediatria per le Emopatie Ereditarie, Centro di Prevenzione Diagnosi e Cura della Talassemia, A.O. "G. Di Cristina", Palermo, Italy
| | - Francesco Gagliardotto
- U.O.C. 7a Pediatria per le Emopatie Ereditarie, Centro di Prevenzione Diagnosi e Cura della Talassemia, A.O. "G. Di Cristina", Palermo, Italy
| | - Aldo Filosa
- U.O.D. Malattie Rare del Globulo Rosso, A.O.R.N. "A. Cardarelli", Napoli, Italy
| | | | - Crocetta Argento
- U.O.C. Medicina Trasfusionale, A.O. "S. Giovanni di Dio", Agrigento, Italy
| | | | - Michele Rizzo
- U.O.C. Ematologia, A.O. "S. ELIA", Caltanissetta, Italy
| | | | - Carmelo Fidone
- U.O.C. Centro Trasfusionale, A.O. "M. Paternò Arezzo", Ragusa, Italy
| | - Maria Fustaneo
- Campus of Haematology Franco e Piera Cutino - A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Rosario Di Maggio
- Campus of Haematology Franco e Piera Cutino - A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Aurelio Maggio
- Campus of Haematology Franco e Piera Cutino - A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
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