Hydroxyurea therapy lowers transcranial Doppler flow velocities in children with sickle cell anemia
| Autor: | William H. Schultz, Shelly Burgett, Nicole A. Mortier, Russell E. Ware, Sherri A. Zimmerman |
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| Rok vydání: | 2007 |
| Předmět: |
Male
Middle Cerebral Artery medicine.medical_specialty Blood transfusion Maximum Tolerated Dose Ultrasonography Doppler Transcranial Anemia medicine.medical_treatment Immunology Anemia Sickle Cell Biochemistry Antisickling Agents Internal medicine Multicenter trial medicine Humans Hydroxyurea Blood Transfusion Prospective Studies Child Prospective cohort study business.industry Cell Biology Hematology medicine.disease Sickle cell anemia Transcranial Doppler Surgery Stroke Child Preschool Maximum tolerated dose Stroke prevention cardiovascular system Cardiology Female business Blood Flow Velocity |
| Zdroj: | Blood. 110:1043-1047 |
| ISSN: | 1528-0020 0006-4971 |
| DOI: | 10.1182/blood-2006-11-057893 |
| Popis: | Hydroxyurea has hematologic and clinical efficacy in sickle cell anemia (SCA), but its effects on transcranial Doppler (TCD) flow velocities remain undefined. Fifty-nine children initiating hydroxyurea therapy for clinical severity had pretreatment baseline TCD measurements; 37 with increased flow velocities (≥ 140 cm/s) were then enrolled in an institutional review board (IRB)–approved prospective phase 2 trial with TCD velocities measured at maximum tolerated dose (MTD) and one year later. At hydroxyurea MTD (mean ± 1 SD = 27.9 ± 2.7 mg/kg per day), significant decreases were observed in the right middle cerebral artery (MCA) (166 ± 27 cm/s to 135 ± 27 cm/s, P < .001) and left (MCA) (168 ± 26 cm/s to 142 ± 27 cm/s, P < .001) velocities. The magnitude of TCD velocity decline was significantly correlated with the maximal baseline TCD value. At hydroxyurea MTD, 14 of 15 children with conditional baseline TCD values improved, while 5 of 6 with abnormal TCD velocities whose families refused transfusions became less than 200 cm/s. TCD changes were sustained at follow-up. These prospective data indicate that hydroxyurea can significantly decrease elevated TCD flow velocities, often into the normal range. A multicenter trial is warranted to determine the efficacy of hydroxyurea for the management of increased TCD values, and ultimately for primary stroke prevention in children with SCA. |
| Databáze: | OpenAIRE |
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