Serious morbidity and mortality in sickle cell anemia (SCA) is well-described and begins early in life with the onset of the physiologic decline of fetal hemoglobin (HbF). The BABY HUG trial showed that 20mg/kg/day of hydroxyurea therapy is safe, blunts the decline of HbF, and is clinically beneficial for very young infants and children with SCA. Nevertheless, children treated with hydroxyurea continued to develop acute complications and acquired end organ damage. Hydroxyurea therapy is now suggested to be offered to all very young children with sickle cell anemia, whether or not they have clinical symptoms. The BABY HUG trial established the safety and efficacy of fixed dosages of hydroxyurea therapy in this very young group of children; however, it is now paramount to define the optimal dosing regimen to maximize benefit. We believe that defining the clinical and hematologic impact of intensified dosages versus fixed dosing of hydroxyurea in this age group is crucial. The primary aims of this planning grant are to establish a multicenter infrastructure that will identify, enroll, and randomize very young children (9-36 months) using fixed vs. intensified dose HU in a single-blinded manner and to obtain prospective pilot data comparing the clinical and laboratory efficacy of intensified and fixed-dose HU. The HUGKISS trial is the next logical step to improve upon BABY HUG outcomes and advance the care of patients with SCA.

Public Health Relevance

Children with sickle cell anemia may experience severe complications early in life, and these complications may be decreased in frequency and severity with the routine administration of hydroxyurea. The relevance of the proposed planning grant is that it seeks to answer a basic question which remains after the publication of the BABY HUG study. That is, does escalation provide a clinical benefit in young children with sickle cell anemia? Extrapolation from the adult literature with hydroxyurea suggests that escalation is beneficial, but the large reductions in clinical events observed in the fixed-dose BABY HUG trial call for this question to be addressed through a clinical trial.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Planning Grant (R34)
Project #
5R34HL127162-03
Application #
9462681
Study Section
Clinical Trials Review Committee (CLTR)
Program Officer
Werner, Ellen
Project Start
2016-04-01
Project End
2019-03-31
Budget Start
2018-04-01
Budget End
2019-03-31
Support Year
3
Fiscal Year
2018
Total Cost
Indirect Cost
Name
St. Jude Children's Research Hospital
Department
Type
DUNS #
067717892
City
Memphis
State
TN
Country
United States
Zip Code
38105
Estepp, Jeremie H; Smeltzer, Matthew P; Kang, Guolian et al. (2017) A clinically meaningful fetal hemoglobin threshold for children with sickle cell anemia during hydroxyurea therapy. Am J Hematol 92:1333-1339