Thanks Juanita, this is awesome. I'm glad that I am able to collect all the info possible and know my options. Thanks!
Dear Juanita,
Thank you for your question. This decision should definitely be discussed
with her doctor very carefully, not an e-mail decision, but this is
background information for you. The sections below are what I tell the
families of children with sickle cell when they ask about hydroxyurea.Ã
Whether hydroxyurea is right for your daughter depends on:
1) the severity of her sickle cell disease
2) whether any of her organs have suffered damage that might be worsened
by hydroxyurea -brain, kidney, liver, hip joints.
3) willing to avoid getting pregnant while on hydroxyurea - due to risk of
birth defects
4) willing to get frequent monitoring of blood counts
5) willing to accept an unknown chance ofà increased risk of cancer
6) willing to take a daily capsule even when she feels OK
7) willing to wait possibly several months for the onset of hydroxyurea
benefit - individualized dose adjustment, may take a while
We take the decision for hydroxyurea very very seriously.Ã Our current
practice is to have the child's family discuss hydroxyurea with us at
several visits spread over a couple months, then to sign this consent form
to document that we have discussed the risks & benefits of hydroxyurea,
and document their willingness to accept this treatment even though it is
not experimental trial.Ã http://www.scinfo.org/hydreaPt.htm
Hydroxyurea info written for doctors is at
http://www.scinfo.org/hydrea.htmà Ã
Sincerely,
-Lewis Hsu, MD, PhD
Emory University Pediatric Hematology-Oncology-BMT
Section about hydroxyurea for pediatric sickle cell ,Ã from my article in
drspock.comà à à 2/1/01Ã
http://www.drspock.com/article/0,1510,5073+Health+TOP-467,00.html
What is Hydroxyurea treatment for sickle cell?
As you may have already learned, hydroxyurea is the first effective
medication for treatment of sickle cell disease (the first out of several
hundred medications tested over the decades).Ã Ã It has been tested most
extensively in adults, and there had been a lot of doctors waiting to see
whether children would have similar benefit from hydroxyurea.
Pediatric studies have been completed in the past couple yearsà - some
published and others discussed in meetings but not yet in print - showing
that children have similar benefit in making their sickle cell disease
milder, perhaps even more benefit than the adults get.Ã There had been
worries that hydroxyurea would interfere with growth or development, but
that has not been found in the pediatric hydroxyurea studies.Ã Therefore,
hydroxyurea is becoming more widely accepted for use in pediatric sickle
cell patients, with many centers treating adolescents and school-aged
children.Ã Some centers are now doing studies with giving hydroxyurea to
pre-schoolers and infants with sickle cell disease.
Why doesnââ¬â¢t everybody with sickle cell get treated with hydroxyurea?
The POSSIBLE long-term side effects are: increased risk of cancer, and
increased risk of birth defects.Ã The worries about cancer are based upon
hydroxyurea treatment for people without sickle cell disease, who have
blood disorders that predispose them to leukemia, having a slightly higher
rate of leukemia.Ã The worries about birth defects are based upon rat
studies.Ã Thus far, no increased cancer rate nor birth defects have been
reported in people with sickle cell disease on hydroxyurea treatment.
Several hundred adults with sickle cell disease are on hydroxyurea in the
USA, and a registry is being set up to track long-term side effects.
Some doctors are also worried about giving hydroxyurea to infants, because
animal studies suggest that hydroxyurea may interfere with brain growth
during that period of rapid brain development.Ã No actual human problems
with brain development have yet been seen.Ã Specialists in brain
development feel that children over 3 years of age have completed most of
their brain growth and will not be as sensitive to hydroxyurea-induced
problems, but there are no studies.
The actual long-term side effects are unknown, and will not be known until
many sickle cell patients have been treated for long term.Ã Presently,
only a handful have been treated for more than 12 years (the first
studies) and most people for less than 6 years (the second wave of
studies).
Who decides which person with sickle cell gets hydroxyurea?
We generally offer hydroxyurea treatment for children whose sickle cell
disease has been particularly severe, with frequent hospitalizations for
pain or lung problems.Ã We do not offer hydroxyurea for children who have
had stroke, although studies are beginning to see whether that will be
helpful.Ã We also ask that the child come in for blood counts every 2 to 4
weeks while on hydroxyurea, in order to watch for the potential to lower
the blood counts too much, and adjust the dosage slowly and carefully over
a few months to arrive at the individualized dosage.Ã
We discuss the benefits and risks with the families at great length, in at
least 2 sessions over a few weeks, and I have found that about one-third
of the families consider the unknown long-term risks unacceptable and
decline hydroxyurea.Ã A few teenagers have started the hydroxyurea and
then quit after a few months because they thought it was too inconvenient
to take the daily hydroxyurea and come soà frequently for lab tests.à Most
of the people on hydroxyurea have felt it to be very helpful in decreasing
the severity of their sickle cell disease, even though it does not cure
them completely.