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Fertility and hydroxyurea

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Manal:
Dear Kathleen

Thanks a lot for your words.  They are so encourging and makes me feel that i should not be afraid to give it a try.  I too wish that we are doing the best for our children. 
Kahleen, have you ever thought of bone marrow transplant to Olivia? And did the doctors discussed with you the future of thal intermedia children and what we should expect?

Again thanks a lot for your advice and encourgment

Take care

Manal

Andy Battaglia:
Hi Kathleen,

I know there are questions about the long term use of hydroxyurea, but in the short term, since Olivia Mary is so young, I think keeping a high Hb is essential. Many of the biggest probems thals have are development related, as low Hb can cause so many problems as a child develops. Maintaining her Hb now is well worth it as she will have a chance to develop normally during these years. Once a child passes puberty, physical development slows and and the higher Hb is not as critical an issue in regards to growth. You've seen first hand what a difference there is in her since she is maintaining a higher HB. At this point in her life I feel that possible side effects are outweighed by the benefits of hydroxyurea use.

Hallu:
Does anybody know about the possible side effects of Hydroxy Urea treatment ?  Hydroxy Urea treatment is also referred as a slow chemotherapy treatment...slow becoz amount of dose is very less as compared to normal chemotherapy. Does that mean it can have same side effects as chemotherapy, if used for long time?
So far we know that it may(or maynot) affect fertility and decrease WBC count. But other than these, do we know of other possible side effects?

Thanks,
Hallu

Andy Battaglia:
Chemotherapy is a term that covers many drugs with many different side effects. Because of the stigma of the chemotherapy word, the term is normally avoided when talking about hydroxyurea use in thalassemics. Hydroxyurea has none of the typical side effects of the harsher drugs often used in chemotherapy and the dosage used in thal is lower than what is used in chemo.

Studies have shown few if any side effects in thal patients using hydroxyurea but more studies need to be done both to determine long term safety and also effectiveness in major.

From http://www.bloodjournal.org/cgi/content/abstract/87/3/887?ck=nck


--- Quote ---Hydroxyurea increases hemoglobin F levels and improves the effectiveness of erythropoiesis in beta-thalassemia/hemoglobin E disease...Almost all patients responded with an average increase of 33% in Hb F levels... there was also a slight (10%) but statistically significant increase in hemoglobin levels and an improved balance in alpha:non-alpha globin chains ratios. The side effects were minimal in most patients, although these patients tended to tolerate a lower dose of HU before significant myelosuppression than has been our previous experience in sickle cell disease. One splenectomized patient died of sepsis during the trial. We conclude that increased Hb F production in beta-thalassemia/Hb E patients, with an improvement in the alpha:non-alpha globin ratios and, probably, the effectiveness of erythropoiesis, can be achieved using HU. Longer trials of HU in this population, including at other doses and in combination with other agents, appear warranted.
--- End quote ---

The further research into hydroxyurea and any other drugs or substances that can raise HbF levels is very much warranted and much more emphasis needs to be placed on this approach to thalassemia. Eliminating the need for transfusion is the most important thing that can be done for thals as it also eliminates the iron build up and risk of disease that comes from transfusions. We must demand that more research be done in this field, as it is known that this approach does work and that there are other drugs that can also be used to increase HbF.

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