1
|
Kihlberg K, Baghaei F, Bruzelius M, Funding E, Andre Holme P, Lassila R, Nummi V, Ranta S, Gretenkort Andersson N, Berntorp E, Astermark J. No difference in quality of life between persons with severe haemophilia A and B. Haemophilia 2023; 29:987-996. [PMID: 36791275 DOI: 10.1111/hae.14759] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Good health-related quality of life (HRQoL) is an important goal in the treatment of persons with haemophilia B (PwHB). Studies focusing on this population are limited, however, and data are insufficient. AIM To assess the HRQoL in PwHB and to compare this to data on persons with haemophilia A (PwHA), as well as to evaluate the impact of joint health on HRQoL and to identify areas of insufficient care. METHODS The B-NORD study enrolled persons with severe haemophilia B and matched controls with haemophilia A. HRQoL was assessed using the EQ-5D-3L questionnaire and joint health using Haemophilia Joint Health Score 2.1 (HJHS). RESULTS The EQ-5D-3L was completed by 63 PwHB and 63 PwHA. Mobility problems were reported by 46% of PwHB and 44% of PwHA, pain/discomfort by 62% and 56%, and anxiety/depression by 33% and 17%, respectively. No significant difference was observed between PwHA and PwHB in EQ-5D profiles, level sum score, EQ-5D index (PwHB mean .80, PwHA mean .83, p = .24), or EQ VAS score (PwHB: mean 70, PwHA: mean 77, p = .061). Linear regression adjusted for age demonstrated that an increase in HJHS score was associated with a significant decrease in both EQ-5D index (B -.003, R2 .22) and EQ VAS score (B -.37, R2 .17). CONCLUSION Despite the majority of patients being treated with prophylaxis, impaired HRQoL was reported in both PwHB and PwHA. No differences in HRQoL were found between the two groups. Impaired joint health had a significant negative impact on HRQoL.
Collapse
Affiliation(s)
- Kristina Kihlberg
- Clinical Coagulation Research, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Haematology, Oncology and Radiation Physics, Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
| | - Fariba Baghaei
- Department of Haematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Bruzelius
- Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Eva Funding
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Pål Andre Holme
- Department of Haematology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Riitta Lassila
- Department of Haematology, Coagulation Disorders Unit, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Research Programme in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Vuokko Nummi
- Department of Haematology, Coagulation Disorders Unit, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Research Programme in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Susanna Ranta
- Paediatric Coagulation, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Paediatric Oncology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Nadine Gretenkort Andersson
- Department of Haematology, Oncology and Radiation Physics, Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences and Paediatrics, Lund University, Lund, Sweden
- Department of Paediatric Haematology and Oncology, Skåne University Hospital, Lund, Sweden
| | - Erik Berntorp
- Clinical Coagulation Research, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jan Astermark
- Clinical Coagulation Research, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Haematology, Oncology and Radiation Physics, Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
2
|
Augustsson C, Norström E, Andersson NG, Zetterberg E, Astermark J, Strandberg K. Monitoring standard and extended half-life products in hemophilia: Assay discrepancies for factor VIII and IX in pre- and postinfusion samples. Res Pract Thromb Haemost 2020; 4:1114-1120. [PMID: 33134777 PMCID: PMC7590307 DOI: 10.1002/rth2.12421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/29/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Monitoring hemophilia treatment with extended half-life products is challenging for coagulation laboratories since factor assays may show substantial differences between results obtained with the one-stage assay (OSA) and the chromogenic substrate assay (CSA). OBJECTIVES The aim of this study was to evaluate and compare different factor assays and global coagulation methods. METHODS Factor VIII (FVIII) and IX (FIX) activities and global assay parameters were analyzed in pre- and postinfusion samples (5 patients 2 samples/product/method). RESULTS Samples containing FVIII products (NovoEight, Elocta, and Nuwiq) gave higher levels when measured with CSA compared to OSA. The correlation was excellent (r 2 ≥ .97) while biases of 42%-72% of mean (CSA-OSA) were obtained. With FVIII (OSA) as independent variable, the correlations to kaolin clot time (CT) and thrombin generation assay (TGA) peak were modest (r2 = .71-.72 and .64-.65, respectively), except for Nuwiq for which there was a poor correlation to TGA peak (r 2 = .08). Samples containing Alprolix, a FIX product, gave a smaller difference between activity levels (CSA-OSA), and the correlation was excellent (r 2 = .96). With FIX (CSA) as independent variable for both Alprolix and Refixia, the correlations to Innovin CT and TGA peaks were weak (r 2 = .33-.45 and .44-.76, respectively). CONCLUSIONS Our data show that factor activity assays differ between methods used and agents. These discrepancies indicate the value of having more than one type of assay available in the coagulation laboratory when monitoring hemophilia treatment with extended half-life products. Global assays gave complementary information indicated by the modest correlations to factor activities.
Collapse
Affiliation(s)
- Cecilia Augustsson
- Division of Laboratory Medicine, CoagulationDepartment of Clinical Chemistry and PharmacologyUniversity and Regional Laboratories Region SkåneMalmöSweden
| | - Eva Norström
- Division of Laboratory Medicine, CoagulationDepartment of Clinical Chemistry and PharmacologyUniversity and Regional Laboratories Region SkåneMalmöSweden
| | - Nadine Gretenkort Andersson
- Department of Hematology, Oncology and Radiation PhysicsCenter for Thrombosis and HemostasisSkåne University HospitalLund UniversityMalmöSweden
| | - Eva Zetterberg
- Department of Hematology, Oncology and Radiation PhysicsCenter for Thrombosis and HemostasisSkåne University HospitalLund UniversityMalmöSweden
| | - Jan Astermark
- Department of Hematology, Oncology and Radiation PhysicsCenter for Thrombosis and HemostasisSkåne University HospitalLund UniversityMalmöSweden
| | - Karin Strandberg
- Division of Laboratory Medicine, CoagulationDepartment of Clinical Chemistry and PharmacologyUniversity and Regional Laboratories Region SkåneMalmöSweden
| |
Collapse
|
3
|
Navred K, Martin M, Ekdahl L, Zetterberg E, Andersson NG, Strandberg K, Norstrom E. A simplified flow cytometric method for detection of inherited platelet disorders-A comparison to the gold standard light transmission aggregometry. PLoS One 2019; 14:e0211130. [PMID: 30673773 PMCID: PMC6343919 DOI: 10.1371/journal.pone.0211130] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 07/19/2018] [Accepted: 01/08/2019] [Indexed: 12/30/2022] Open
Abstract
Background Flow cytometric platelet activation has emerged as an alternative diagnostic test for inherited platelet disorders. It is, however, labor intensive and few studies have directly compared the performance of flow cytometric platelet activation (PACT) to light transmission aggregometry (LTA). The aims of this study were 1/ to develop a simplified flow cytometric platelet activation assay using microtiter plates and 2/ to correlate the outcome to gold standard method LTA, and to clinical bleeding assessment tool scores (BAT score). Methods The PACT method was developed in microtiter plates using adenosine diphosphate (ADP), collagen-derived peptide (CRP-XL) and thrombin receptor activator for peptide 6 (TRAP-6) as agonists. Antibodies against GPIIb-IIIa activation epitope (PAC1), P-selectin (CD62P) and lysosome-associated membrane glycoprotein 3 (LAMP3; CD63) were used as platelet activation markers. Sixty-six patients referred to the coagulation unit for bleeding symptoms were included in this single-center observational study. Platelet activation was determined by PACT and LTA. The results of both methods were correlated to BAT score. Results A two-by-two analysis using Cohen’s kappa analysis gave moderate agreement between LTA and PACT (82%, kappa = 0.57), when PACT analysis with ADP and CRP-XL was compared to LTA. Using LTA as reference method, positive predictive value was 70% and negative predictive value was 87%. A substantial number of patients had high BAT score and normal LTA and PACT results. Patients with abnormal LTA or PACT results had higher BAT score than patients with normal results, but the difference was not significant. Conclusions The performance in microtiter plates simplified the PACT method and enabled analysis of more patients at the same time. Our results indicate that with modification of the current PACT assay, a higher negative predictive value can be obtained. Furthermore, with comparable result to LTA the PACT could be used as a screening assay for inherited platelet disorders.
Collapse
Affiliation(s)
- Kristoffer Navred
- Coagulation Laboratory, Department of Clinical Chemistry, Division of Laboratory Medicine, Skåne County Council, Malmö, Sweden
| | - Myriam Martin
- Coagulation Laboratory, Department of Clinical Chemistry, Division of Laboratory Medicine, Skåne County Council, Malmö, Sweden
| | - Lina Ekdahl
- Coagulation Laboratory, Department of Clinical Chemistry, Division of Laboratory Medicine, Skåne County Council, Malmö, Sweden
| | - Eva Zetterberg
- Department of Haematology, Coagulation Unit, Skåne University Hospital, Lund, Sweden
| | | | - Karin Strandberg
- Coagulation Laboratory, Department of Clinical Chemistry, Division of Laboratory Medicine, Skåne County Council, Malmö, Sweden
| | - Eva Norstrom
- Department of Translational Medicine, Lund University, Skåne County Council, Malmö, Sweden
- * E-mail:
| |
Collapse
|
4
|
Stoffman J, Andersson NG, Branchford B, Batt K, D'Oiron R, Escuriola Ettingshausen C, Hart DP, Jiménez Yuste V, Kavakli K, Mancuso ME, Nogami K, Ramírez C, Wu R. Common themes and challenges in hemophilia care: a multinational perspective. ACTA ACUST UNITED AC 2018; 24:39-48. [PMID: 30073913 DOI: 10.1080/10245332.2018.1505225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To identify ways that provision of hemophilia care can be maximized at the local level, irrespective of available resources or cultural or geographic challenges. METHODS The SHIELD group used its multinational experience to share examples of local initiatives that have been employed to deliver optimal hemophilia care. RESULTS The examples were reviewed and categorized into four key themes: guidelines and algorithms for delivery of care; collaboration with patients and allied groups for care and education; registries for the monitoring of treatment and outcomes and health care planning and delivery; and opportunities for personalization of care. These themes were then incorporated into a road map for collaborative care in hemophilia that reflected the contribution of best practice. DISCUSSION Differing healthcare reimbursement systems, budgetary constraints, and geographical and cultural factors make it difficult for any country to fully deliver ideal care for people with hemophilia. The SHIELD approach for collaborative care provides illustrative examples of how four key themes can be used to optimize hemophilia care in any setting. ABBREVIATIONS AHCDC: Association of Hemophilia Clinic Directors of Canada; AICE: Italian Association of Hemophilia Centres; ATHN: American Thrombosis and Hemostasis Network; EAHAD: European Association for Haemophilia and Allied Disorders; EHC: European Hemophilia Consortium; FIX: Coagulation Factor IX; FVIII: Coagulation Factor VIII; HAL: Haemophilia Activity List; HJHS: Haemophilia Joint Health Score; HTC: Hemophilia Treatment Centre; HTCCNC: Hemophilia Treatment Centre Collaborative Network of China; MASAC: Medical and Scientific Advisory Council; MDT: Multidisciplinary team; NHD: National Haemophilia Database; NHF: National Hemophilia Foundation; PK: Pharmacokinetics; POCUS: Point of care ultrasound; PWH: People with haemophilia; SHIELD: Supporting Hemophilia through International Education, Learning and Development; WFH: World Federation of Hemophilia.
Collapse
Affiliation(s)
- J Stoffman
- a Department of Pediatrics and Child Health , University of Manitoba , Winnipeg , Canada
| | - N G Andersson
- b Department for Thrombosis and Haemostasis Hematology , Skåne University Hospital , Scania , Sweden
| | - B Branchford
- c School of Medicine Research Complex 1 , University of Colorado , Aurora , CO , USA
| | - K Batt
- d Wake Forest Baptist University Medical Center, 1 Medical Center Blvd , Winston-Salem , NC , USA
| | - R D'Oiron
- e Centre de Traitement de l'Hémophilie et Maladies Hémorragiques Constitutionnelles Rares , Hôpitaux Universitaires Paris Sud - Hôpital Bicêtre , Le Kremlin-Bicêtre Cedex , France
| | | | - D P Hart
- g The Royal London Hospital Haemophilia Centre , Barts and The London School of Medicine & Dentistry , London , UK
| | - V Jiménez Yuste
- h Hospital Universitario La Paz - Hematology , Madrid , Spain
| | - K Kavakli
- i Department of Hematology , Ege University Children's Hospital , Izmir , Turkey
| | - M E Mancuso
- j Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre , University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan , Milan , Italy
| | - K Nogami
- k Department Pediatrics , Nara Medical University , Kashihara, Nara , Japan
| | - C Ramírez
- l Clinica Colsanitas , Fundación Universitaria Sanitas , Bogota , Colombia
| | - R Wu
- m Hemophilia Work Group, Hematology-Oncology Center , Beijing Children's Hospital affiliated to Capital Medical University , Beijing , People's Republic of China
| |
Collapse
|
5
|
Tuckuviene R, Ranta S, Albertsen BK, Andersson NG, Bendtsen MD, Frisk T, Gunnes MW, Helgestad J, Heyman MM, Jonsson OG, Mäkipernaa A, Pruunsild K, Tedgård U, Trakymiene SS, Ruud E. Prospective study of thromboembolism in 1038 children with acute lymphoblastic leukemia: a Nordic Society of Pediatric Hematology and Oncology (NOPHO) study. J Thromb Haemost 2016; 14:485-94. [PMID: 26707629 DOI: 10.1111/jth.13236] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 04/14/2015] [Indexed: 01/19/2023]
Abstract
UNLABELLED ESSENTIALS: Children with acute lymphoblastic leukemia (ALL) are at risk of thromboembolism (TE). This is a prospective evaluation of the incidence, risk factors and outcomes of TE in 1038 children with ALL. TE occurred in 6.1% of children, with the highest incidence (20.5%) among those aged 15-17 years. A TE-associated case fatality of 6.4% indicates that TE is a severe complication of ALL treatment. SUMMARY BACKGROUND Thromboembolism (TE) is a major toxicity in children with acute lymphoblastic leukemia (ALL) and may have a negative impact on ALL treatment. OBJECTIVES To examine the cumulative incidence, outcomes and risk factors associated with TE in children with leukemia. PATIENTS/METHODS We prospectively evaluated TE in 1038 Nordic children and adolescents (≥ 1 and < 18 years) diagnosed with ALL during 2008-2013 and treated according to the NOPHO (Nordic Society of Pediatric Hematology and Oncology)-ALL 2008 protocol. The cohort was followed until December 2014. Cox proportional regression was used to compute hazard ratios (HRs). RESULTS TE events (n = 63) occurred most frequently in conjunction with asparaginase (ASP) administration (52/63). The cumulative incidence of TE was 6.1% (95% confidence interval [CI], 4.8-7.7). Being aged 15-17 years was associated with an increased risk of TE (adjusted HR of 4.0; 95% CI, 2.1-7.7). We found a TE-associated 30-day case fatality of 6.4% (95% CI, 1.8-15.5) and TE-related truncation of ASP therapy in 36.2% (21/58). Major hemorrhage occurred in 3.5% (2/58) of anticoagulated patients. Minor hemorrhage was reported in two out of 58 patients. No major bleeds occurred in children who received low-molecular-weight heparin. CONCLUSIONS Methods to identify children and adolescents who will benefit from thromboprophylaxis during ALL treatment are called for. The truncation of ASP should be avoided. The long-term survival outcomes for ALL patients with TE require close monitoring in the future.
Collapse
Affiliation(s)
- R Tuckuviene
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - S Ranta
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - B K Albertsen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - N G Andersson
- Departments of Pediatrics and Coagulation Disorders, University of Lund, University Hospital, Malmö, Sweden
| | - M D Bendtsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - T Frisk
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - M W Gunnes
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - J Helgestad
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - M M Heyman
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - O G Jonsson
- Children's Hospital, Landspitali University Hospital, Reykjavík, Iceland
| | - A Mäkipernaa
- Children's Hospital and Department of Hematology, Cancer Center, Helsinki University Central Hospital, Helsinki, Finland
| | - K Pruunsild
- Department of Oncohematology, Tallinn Children's Hospital, Tallinn, Estonia
| | - U Tedgård
- Departments of Pediatrics and Coagulation Disorders, University of Lund, University Hospital, Malmö, Sweden
| | - S S Trakymiene
- Center for Pediatric Oncology and Hematology, Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - E Ruud
- Department of Pediatric Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| |
Collapse
|
6
|
Ljung R, Gretenkort Andersson N. The current status of prophylactic replacement therapy in children and adults with haemophilia. Br J Haematol 2015; 169:777-86. [DOI: 10.1111/bjh.13365] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Rolf Ljung
- Department of Clinical Sciences Lund-Paediatrics; Lund University; Lund Sweden
- Department of Paediatrics and Malmö Centre for Thrombosis and Haemostasis; Skåne University Hospital; Malmö Sweden
| | - Nadine Gretenkort Andersson
- Department of Paediatrics and Malmö Centre for Thrombosis and Haemostasis; Skåne University Hospital; Malmö Sweden
| |
Collapse
|
7
|
Ranta S, Tuckuviene R, Mäkipernaa A, Albertsen BK, Frisk T, Tedgård U, Jónsson ÓG, Pruunsild K, Gretenkort Andersson N, Winther Gunnes M, Saulyte Trakymiene S, Frandsen T, Heyman M, Ruud E, Helgestad J. Cerebral sinus venous thromboses in children with acute lymphoblastic leukaemia - a multicentre study from the Nordic Society of Paediatric Haematology and Oncology. Br J Haematol 2014; 168:547-52. [PMID: 25288392 DOI: 10.1111/bjh.13162] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [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: 06/08/2014] [Accepted: 08/29/2014] [Indexed: 11/27/2022]
Abstract
We present a prospective multicentre cohort of 20 children with acute lymphoblastic leukaemia (ALL) and cerebral sinus venous thrombosis (CSVT). The study covers a period of 5 years and comprises 1038 children treated according to the Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL 2008 protocol. The cumulative incidence of CSVT was 2%. Sixteen of the thromboses were related to asparaginase and 16 to steroids. Most CSVTs occurred in the consolidation phase. Nearly all were treated with low molecular weight heparin without bleeding complications. Mortality related to CSVT directly or indirectly was 10%, emphasizing the importance of this complication.
Collapse
Affiliation(s)
- Susanna Ranta
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|