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Effects of Hydroxyurea on Brain Function in Children with Sickle Cell Anemia
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  • Winfred Wang,
  • Ping Zou,
  • Scott Hwang,
  • Guolian Kang,
  • Juan Ding,
  • Andrew Heitzer,
  • Jane Schreiber,
  • Kathleen Helton,
  • Jane Hankins
Winfred Wang
St Jude Children's Research Hospital
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Ping Zou
St. Jude Children's Research Hospital
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Scott Hwang
St. Jude Children's Research Hospital
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Guolian Kang
St.Jude Children's Research Hospital
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Juan Ding
St. Jude Children’s Research Hospital Memphis
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Andrew Heitzer
St Jude Children's Research Hospital
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Jane Schreiber
Children's Hospital of Philadelphia
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Kathleen Helton
St Jude Children's Research Hospital
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Jane Hankins
St Jude Children's Research Hospital
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Abstract

Introduction: Sickle cell anemia (SCA) results in numerous adverse effects on the brain, including ischemic lesions and neurocognitive dysfunction. Hydroxyurea has been utilized extensively for management of SCA, but its effects on brain function have not been established. Methods: We examined prospectively the effects of one year of treatment with hydroxyurea on brain function in a cohort of children with SCA (HbSS/HbSβ0-thalassemia) by baseline and exit evaluations, including comprehensive neurocognitive testing, transcranial Doppler ultrasound (TCD), and brain MRI [silent cerebral infarcts (SCI), gray matter cerebral blood flow (GM-CBF), and blood oxygen level dependent (BOLD) signal from visual stimulation]. Results: Nineteen patients with SCA, mean age 12.4 years (range 7.2-17.8), were evaluated. At baseline, subjects had these mean values: full scale IQ (FSIQ) 81.9, TCD velocity 133 cm/sec, GM-CBF 64.4 ml/100g/min, BOLD signal 2.34% increase, and frequency of SCI 47%. After one year of hydroxyurea, there were significant increases in FSIQ (+2.8, p=0.036) and reading comprehension (+4.8, p=0.016), a significant decrease in TCD velocity (-11.4 cm/sec, p=0.007), and no significant changes in GM-CBF, BOLD, or SCI frequency. Furthermore, FSIQ was associated with higher hemoglobin F (HbF) and lower GM-CBF, but not with hemoglobin level. Discussion: Significant improvement of neurocognition and decreased TCD velocity following one year of treatment support the use of hydroxyurea for improving neurocognitive outcomes in SCA. Understanding the mechanisms of benefit, as indicated by relationships of neurocognitive function with HbF, hemoglobin, and CBF, requires further evaluation.

Peer review status:ACCEPTED

26 Feb 2021Submitted to Pediatric Blood & Cancer
26 Feb 2021Submission Checks Completed
26 Feb 2021Assigned to Editor
27 Feb 2021Reviewer(s) Assigned
15 Mar 2021Review(s) Completed, Editorial Evaluation Pending
16 Mar 2021Editorial Decision: Revise Major
10 Jun 20211st Revision Received
10 Jun 2021Submission Checks Completed
10 Jun 2021Assigned to Editor
17 Jun 2021Reviewer(s) Assigned
05 Jul 2021Review(s) Completed, Editorial Evaluation Pending
07 Jul 2021Editorial Decision: Accept