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O'Brien NF, Moons P, Johnson H, Tshimanga T, Musungufu DA, Ekandji RT, Mbaka JP, Babatila LK, Mayindombe L, Giresse B, Mwanza S, Lupumpaula C, Chilima JS, Nanyangwe A, Kabemba P, Kafula LN, Phiri T, June S, Gushu MB, Chagaluka G, Chunda‐Liyoka CM. Transcranial Doppler ultrasound velocities in a population of unstudied African children with sickle cell anemia. EJHaem 2024; 5:3-10. [PMID: 38406536 PMCID: PMC10887331 DOI: 10.1002/jha2.818] [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] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/09/2023] [Accepted: 10/16/2023] [Indexed: 02/27/2024]
Abstract
The greatest burden of sickle cell anemia (SCA) globally occurs in sub-Saharan Africa, where significant morbidity and mortality occur secondary to SCA-induced vasculopathy and stroke. Transcranial Doppler ultrasound (TCD) can grade the severity of vasculopathy, with disease modifying therapy resulting in stroke reduction in high-risk children. However, TCD utilization for vasculopathy detection in African children with SCA remains understudied. The objective was to perform a prospective, observational study of TCD findings in a cohort of children with SCA from the Democratic Republic of the Congo, Zambia, and Malawi. A total of 770 children aged 2-17 years without prior stroke underwent screening TCD. A study was scored as low risk when the time-averaged maximum of the mean (TAMMX) in the middle cerebral artery or terminal internal carotid artery was <170 cm/s but >50 cm/s, conditional risk when 170-200 cm/s, and high risk when >200 cm/s. Low-risk studies were identified in 604 children (78%), conditional risk in 129 children (17%), and high risk in three children (0.4%). Additionally, 34 (4%) were scored as having an unknown risk study (TAMMX <50 cm/s). Over the course of 15 months of follow-up, 17 children (2.2%) developed new neurologic symptoms (six with low-risk studies, seven with conditional risk, and four with unknown risk). African children with SCA in this cohort had a low rate of high-risk TCD screening results, even in those who developed new neurologic symptoms. Stroke in this population may be multifactorial with vasculopathy representing only one determinant. The development of a sensitive stroke prediction bundle incorporating relevant elements may help to guide preventative therapies in high-risk children.
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Affiliation(s)
- Nicole F. O'Brien
- Department of PediatricsDivision of Critical Care MedicineNationwide Children's Hospital, The Ohio State UniversityColumbusOhioUSA
| | - Peter Moons
- Department of Pediatrics and Child HealthKamuzu University of Health SciencesBlantyreMalawi
| | - Hunter Johnson
- Department of PediatricsDivision of Critical Care MedicineNationwide Children's Hospital, The Ohio State UniversityColumbusOhioUSA
| | - Taty Tshimanga
- Departement de PediatrieCliniques Universitaires de Kinshasa, Hopital Pediatrique de Kalembe Lembe, Universite De KinshasaKimwenzaLembeRepublique Democratic du Congo
| | | | - Robert Tandjeka Ekandji
- Universite des Sciences et des Technologie de Lodja, L'Hopital General de Reference de Lodja, Sankuru DistrictLodjaRepublique Democratic du Congo
| | - Jean Pongo Mbaka
- Universite des Sciences et des Technologie de Lodja, L'Hopital General de Reference de Lodja, Sankuru DistrictLodjaRepublique Democratic du Congo
| | - Lydia Kuseyila Babatila
- Departement de PediatrieCliniques Universitaires de Kinshasa, Hopital Pediatrique de Kalembe Lembe, Universite De KinshasaKimwenzaLembeRepublique Democratic du Congo
| | - Ludovic Mayindombe
- Departement de PediatrieCliniques Universitaires de Kinshasa, Hopital Pediatrique de Kalembe Lembe, Universite De KinshasaKimwenzaLembeRepublique Democratic du Congo
| | - Buba Giresse
- Departement de PediatrieCliniques Universitaires de Kinshasa, Hopital Pediatrique de Kalembe Lembe, Universite De KinshasaKimwenzaLembeRepublique Democratic du Congo
| | - Suzanna Mwanza
- Department of PaediatricsChipata Central HospitalChipataZambia
| | | | | | - Alice Nanyangwe
- University Teaching Hospitals—Children's HospitalLusakaZambia
| | - Peter Kabemba
- University Teaching Hospitals—Children's HospitalLusakaZambia
| | | | - Tusekile Phiri
- Queen Elizabeth Central Hospital, The Blantyre Malaria Project, ChichiriBlantyreMalawi
| | - Sylvester June
- Queen Elizabeth Central Hospital, The Blantyre Malaria Project, ChichiriBlantyreMalawi
| | | | - George Chagaluka
- Department of Pediatrics and Child HealthKamuzu University of Health SciencesBlantyreMalawi
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Marfo K, Dei-Adomakoh Y, Segbefia C, Dwomoh D, Edgal A, Ampah N, Ramachandrachar BC, Subramanyam K, Natarajan A, Egbujo O, Ataga KI. Evaluation of treatment patterns, healthcare resource utilization and cost of illness for sickle cell disease in Ghana: a private medical insurance claims database study. BMC Health Serv Res 2023; 23:1018. [PMID: 37735428 PMCID: PMC10515235 DOI: 10.1186/s12913-023-09984-6] [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: 10/14/2022] [Accepted: 08/29/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is a major public health concern in sub-Saharan Africa, accounting for nearly 75% of the global disease burden. The current analysis evaluated patient characteristics, treatment patterns, healthcare resource utilization (HCRU) and associated costs in patients with SCD based on a Private Medical Insurance Database in Ghana. METHODS This retrospective longitudinal cohort study was conducted using an e-claims database from Ghana (01 January 2015 to 31 March 2021). Patients were stratified by age (0 month to < 2 years, ≥ 2 years to ˂6 years, ≥ 6 years to < 12 years, ≥ 12 years to < 16 years; ≥16 years), vaso-occlusive crisis (VOC) (< 1, ≥ 1 to < 3, and ≥ 3 per year), and continuous enrolment. Study outcomes related to patient characteristics, comorbidities, treatment pattern, HCRU were evaluated for pre- and post-index period (index period was between July 2015 to March 2020). Descriptive analysis was used to analyse different study variables. RESULTS The study included 2,863 patients (mean age: 20.1 years; Min age: 0; Max age: 83; females 56.1%). Overall, 52.2% (n = 1,495) of SCD patients were ≥ 16 years and 17.0% (n = 486) were in the ≥ 2 to ˂6-years age group. The majority of patients aged ≥ 16 years (62.5%) in the database did not have reported VOC episodes, 35.9% of patients had 1 to 3 VOCs per year and 1.5% had ≥ 3 VOCs per year during the follow-up period. Consultation-based prevalence of SCD was 0.5% [95% confidence interval (CI): 0-1.3%] - 1.4% [CI: 0.6-2.2%]. Malaria, upper respiratory tract infection (URTI) and sepsis were the common complications of SCD. Analgesics were the most frequently prescribed medications followed by anti-infectives, hematinics, and antimalarials. Hydroxyurea, a routine standard of care for SCD was under-utilized. SCD patients had median cost incurred for consultation/hospital services of $11.3 (Interquartile range [IQR] $6.2 - $27.2). For patients with VOC, maximum median cost was incurred for medications ($10.9 [IQR $5.0-$32.6]). Overall median healthcare cost was highest for individuals with ≥ 3 VOCs per year during the follow-up period ($166.8 [IQR $70.3-$223.5]). CONCLUSION In this retrospective private insurance claims database analysis, SCD imposes a significant healthcare burden, especially in patients with VOC. There is a need for reimbursed treatment options that could reduce the long-term burden associated with SCD and VOC.
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Affiliation(s)
| | - Yvonne Dei-Adomakoh
- University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Ghana
- University of Ghana Legon, Accra, Ghana
| | - Catherine Segbefia
- University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Ghana
- University of Ghana Legon, Accra, Ghana
| | | | | | | | | | | | - Ashok Natarajan
- IQVIA, 11th Floor Convention Tower, DWTC, Al Saada Street, Dubai, 33083, UAE
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Samuelson C, Radtke S, Zhu H, Llewellyn M, Fields E, Cook S, Huang MLW, Jerome KR, Kiem HP, Humbert O. Multiplex CRISPR/Cas9 genome editing in hematopoietic stem cells for fetal hemoglobin reinduction generates chromosomal translocations. Mol Ther Methods Clin Dev 2021; 23:507-523. [PMID: 34853798 PMCID: PMC8605315 DOI: 10.1016/j.omtm.2021.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 12/26/2022]
Abstract
Sickle cell disease and β-thalassemia are common monogenic disorders that cause significant morbidity and mortality globally. The only curative treatment currently is allogeneic hematopoietic stem cell transplantation, which is unavailable to many patients due to a lack of matched donors and carries risks including graft-versus-host disease. Genome editing therapies targeting either the BCL11A erythroid enhancer or the HBG promoter are already demonstrating success in reinducing fetal hemoglobin. However, where a single locus is targeted, reliably achieving levels high enough to deliver an effective cure remains a challenge. We investigated the application of a CRISPR/Cas9 multiplex genome editing approach, in which both the BCL11A erythroid enhancer and HBG promoter are disrupted within human hematopoietic stem cells. We demonstrate superior fetal hemoglobin reinduction with this dual-editing approach without compromising engraftment or lineage differentiation potential of edited cells post-xenotransplantation. However, multiplex editing consistently resulted in the generation of chromosomal rearrangement events that persisted in vivo following transplantation into immunodeficient mice. The risk of oncogenic events resulting from such translocations therefore currently prohibits its clinical translation, but it is anticipated that, in the future, alternative editing platforms will help alleviate this risk.
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Affiliation(s)
- Clare Samuelson
- Stem Cell and Gene Therapy Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
| | - Stefan Radtke
- Stem Cell and Gene Therapy Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
| | - Haiying Zhu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA
| | - Mallory Llewellyn
- Stem Cell and Gene Therapy Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
| | - Emily Fields
- Stem Cell and Gene Therapy Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
| | - Savannah Cook
- Stem Cell and Gene Therapy Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
| | - Meei-Li W. Huang
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA
| | - Keith R. Jerome
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle WA 98109-1024, USA
| | - Hans-Peter Kiem
- Stem Cell and Gene Therapy Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Olivier Humbert
- Stem Cell and Gene Therapy Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
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Esoh K, Wonkam-Tingang E, Wonkam A. Sickle cell disease in sub-Saharan Africa: transferable strategies for prevention and care. Lancet Haematol 2021; 8:e744-e755. [PMID: 34481550 DOI: 10.1016/s2352-3026(21)00191-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 05/27/2021] [Accepted: 06/10/2021] [Indexed: 12/22/2022]
Abstract
Sickle cell disease can be life-threatening or chronically debilitating for both children and adults. Worldwide, more than 300 000 children are born with sickle cell disease every year, over 75% of whom in sub-Saharan Africa. Increased awareness and early interventions, such as neonate screening and comprehensive care, have led to considerable reductions in mortality in children younger than 5 years in high-income countries. However, sickle cell disease prevention and care have largely been neglected in Africa. Without intervention, 50-90% of affected children in many sub-Saharan African countries die before their fifth birthday. Fortunately, increasing initiatives in sub-Saharan Africa are piloting interventions such as neonate screening and comprehensive care, and as mortality declines, quality of life and increased life expectancy become major targets for interventions. Hydroxyurea (hydroxycarbamide) and haematopoietic stem-cell transplantation have already been shown to be effective therapies in high-income countries, but are either not widely accessible or too expensive for most African populations. These challenges are being alleviated by numerous networks evolving through international collaborations that are positively changing the outlook of sickle cell disease management in sub-Saharan Africa. In this Series paper, we describe the epidemiology, pathophysiology, clinicobiological profile, and psychosocial effects of sickle cell disease in sub-Saharan Africa. We highlight transferable strategies already used for the successful management of the condition and key strategies and recommendations for affordable and comprehensive care on the continent. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Kevin Esoh
- Division of Human Genetics, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Edmond Wonkam-Tingang
- Division of Human Genetics, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, Department of Pathology, University of Cape Town, Cape Town, South Africa; Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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Gyamfi J, Ojo T, Epou S, Diawara A, Dike L, Adenikinju D, Enechukwu S, Vieira D, Nnodu O, Ogedegbe G, Peprah E. Evidence-based interventions implemented in low-and middle-income countries for sickle cell disease management: A systematic review of randomized controlled trials. PLoS One 2021; 16:e0246700. [PMID: 33596221 PMCID: PMC7888630 DOI: 10.1371/journal.pone.0246700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Despite ~90% of sickle cell disease (SCD) occurring in low-and middle-income countries (LMICs), the vast majority of people are not receiving evidence-based interventions (EBIs) to reduce SCD-related adverse outcomes and mortality, and data on implementation research outcomes (IROs) and SCD is limited. This study aims to synthesize available data on EBIs for SCD and assess IROs. METHODS We conducted a systematic review of RCTs reporting on EBIs for SCD management implemented in LMICs. We identified articles from PubMed/Medline, Global Health, PubMed Central, Embase, Web of Science medical subject heading (MeSH and Emtree) and keywords, published from inception through February 23, 2020, and conducted an updated search through December 24, 2020. We provide intervention characteristics for each study, EBI impact on SCD, and evidence of reporting on IROs. MAIN RESULTS 29 RCTs were analyzed. EBIs identified included disease modifying agents, supportive care agents/analgesics, anti-malarials, systemic treatments, patient/ provider education, and nutritional supplements. Studies using disease modifying agents, nutritional supplements, and anti-malarials reported improvements in pain crisis, hospitalization, children's growth and reduction in severity and prevalence of malaria. Two studies reported on the sustainability of supplementary arginine, citrulline, and daily chloroquine and hydroxyurea for SCD patients. Only 13 studies (44.8%) provided descriptions that captured at least three of the eight IROs. There was limited reporting of acceptability, feasibility, fidelity, cost and sustainability. CONCLUSION EBIs are effective for SCD management in LMICs; however, measurement of IROs is scarce. Future research should focus on penetration of EBIs to inform evidence-based practice and sustainability in the context of LMICs. CLINICAL TRIAL REGISTRATION This review is registered in PROSPERO #CRD42020167289.
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Affiliation(s)
- Joyce Gyamfi
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Temitope Ojo
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York, United States of America
| | - Sabrina Epou
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Amy Diawara
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Lotanna Dike
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Deborah Adenikinju
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Scholastica Enechukwu
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
| | - Dorice Vieira
- New York University Health Sciences Library, New York, New York, United States of America
| | - Obiageli Nnodu
- Centre of Excellence for Sickle Cell Disease Research & Training (CESRTA), University of Abuja, Abuja, Nigeria
| | - Gbenga Ogedegbe
- Department of Population Health, New York University Medical Center, New York, New York, United States of America
| | - Emmanuel Peprah
- Global Health Program, New York University School of Global Public Health, New York, New York, United States of America
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York, United States of America
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Claeys A, Van Steijn S, Van Kesteren L, Damen E, Van Den Akker M. Varied Age of First Presentation of Sickle Cell Disease: Case Presentations and Review. Case Rep Med 2021; 2021:8895020. [PMID: 33628264 DOI: 10.1155/2021/8895020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/23/2021] [Accepted: 01/30/2021] [Indexed: 11/17/2022] Open
Abstract
Sickle cell disease is a multisystem condition characterized by hemolytic anemia and vasoocclusion. Not only are the symptoms of the first presentation but also the ages of presentation are very variable. Following three case reports, different causes of possible late presentation are discussed. Many factors are responsible for the age at which sickle cell disease is diagnosed: doctor's delay (unfamiliarity with the disease), patient's delay (education and financial position of the parents, cultural factors), high- versus low-resource country (availability of newborn screening), fetal hemoglobin, reticulocyte count, and genetic modulators, such as SCD genotype, alpha-thalassemia, fetal hemoglobin concentration, and G6PD deficiency. The individual course of sickle cell disease depends on (epi) genetic and environmental properties and the underlying interactions. In further studies, the role of each factor should be evaluated more deeply, and its use as a marker of disease severity or activity should be assessed.
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Campbell AD, Colombatti R, Andemariam B, Strunk C, Tartaglione I, Piccone CM, Manwani D, Asare EV, Boruchov D, Farooq F, Urbonya R, Boatemaa GD, Perrotta S, Sainati L, Rivers A, Rao S, Zempsky W, Sey F, Segbefia C, Inusa B, Antwi-Boasiako C. An Analysis of Racial and Ethnic Backgrounds Within the CASiRe International Cohort of Sickle Cell Disease Patients: Implications for Disease Phenotype and Clinical Research. J Racial Ethn Health Disparities 2021; 8:99-106. [PMID: 32418182 PMCID: PMC7669607 DOI: 10.1007/s40615-020-00762-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 12/13/2022]
Abstract
Millions are affected by sickle cell disease (SCD) worldwide with the greatest burden in sub-Saharan Africa. While its origin lies historically within the malaria belt, ongoing changes in migration patterns have shifted the burden of disease resulting in a global public health concern. We created the Consortium for the Advancement of Sickle Cell Research (CASiRe) to understand the different phenotypes of SCD across 4 countries (USA, UK, Italy, and Ghana). Here, we report the multi-generational ethnic and racial background of 877 SCD patients recruited in Ghana (n = 365, 41.6%), the USA (n = 254, 29%), Italy (n = 81, 9.2%), and the UK (n = 177, 20.2%). West Africa (including Benin Gulf) (N = 556, 63.4%) was the most common geographic region of origin, followed by North America (N = 184, 21%), Caribbean (N = 51, 5.8%), Europe (N = 27, 3.1%), Central Africa (N = 24, 2.7%), and West Africa (excluding Benin Gulf) (N = 21, 2.4%). SCD patients in Europe were primarily West African (73%), European (10%), Caribbean (8%), and Central African (8%). In the USA, patients were largely African American (71%), Caribbean (13%), or West African (10%). Most subjects identified themselves as Black or African American; the European cohort had the largest group of Caucasian SCD patients (8%), including 21% of the Italian patients. This is the first report of a comprehensive analysis of ethnicity within an international, transcontinental group of SCD patients. The diverse ethnic backgrounds observed in our cohort raises the possibility that genetic and environmental heterogeneity within each SCD population subgroup can affect the clinical phenotype and research outcomes.
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Affiliation(s)
- Andrew D Campbell
- Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA.
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA.
| | - Raffaella Colombatti
- Clinic of Pediatric Hematology Oncology, Department of Women's and Child Health, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Biree Andemariam
- Division of Hematology-Oncology, New England Sickle Cell Institute, Neag Comprehensive Cancer Center, UCONN Health, University of Connecticut, Farmington, CT, USA
| | - Crawford Strunk
- ProMedica Russell J. Ebeid Children's Hospital, Toledo, OH, USA
| | - Immacolata Tartaglione
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Connie M Piccone
- Pediatric Hematology/Oncology, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Eugenia Vicky Asare
- Ghana Institute of Clinical Genetics, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Hematology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Donna Boruchov
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Fatimah Farooq
- Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Rebekah Urbonya
- Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
| | | | - Silverio Perrotta
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Laura Sainati
- Clinic of Pediatric Hematology Oncology, Department of Women's and Child Health, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Angela Rivers
- Division of Pediatric Hematology/Oncology, University of Illinois-Chicago, Chicago, IL, USA
| | - Sudha Rao
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
| | - William Zempsky
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Fredericka Sey
- Ghana Institute of Clinical Genetics, Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Baba Inusa
- Department of Pediatric Haematology, Evelina Children's Hospital, Guy's and St. Thomas NHS Trust, London, UK
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