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Asher S, Shah R, Ings S, Horder J, Newrick F, Nesr G, Kesse Adu R, Streetly M, Trompeter S, Lee L, Wisniowski B, Mahmood S, Xu K, Papanikalaou X, McMillan A, Popat R, Yong K, Sive J, Kyriakou C, Rabin N. Haematopoietic stem cell mobilisation followed by high-dose chemotherapy and autologous stem cell transplantation for patients with sickle cell disease and myeloma. Br J Haematol 2023; 202:1224-1227. [PMID: 37488061 DOI: 10.1111/bjh.18990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/12/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Affiliation(s)
- S Asher
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - R Shah
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - S Ings
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - J Horder
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - F Newrick
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - G Nesr
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - R Kesse Adu
- Department of Haematology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - M Streetly
- Department of Haematology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - S Trompeter
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - L Lee
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - B Wisniowski
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - S Mahmood
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - K Xu
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - X Papanikalaou
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - A McMillan
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - R Popat
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - K Yong
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - J Sive
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - C Kyriakou
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - N Rabin
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
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Cannas G, Poutrel S, Heiblig M, Labussière H, Larcher MV, Thomas X, Hot A. Sickle cell disease and acute leukemia: one case report and an extensive review. Ann Hematol 2023:10.1007/s00277-023-05294-3. [PMID: 37269388 DOI: 10.1007/s00277-023-05294-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/22/2023] [Indexed: 06/05/2023]
Abstract
Population-based studies and case reports suggest that there may be an increased risk of acute leukemia associated with sickle cell disease (SCD). Following the description of a new case report, an extensive review of the literature identified 51 previously described cases. Most cases study showed myelodysplastic features confirmed, when available, by genetic markers such as chromosome 5 and/or chromosome 7 abnormalities and TP53 gene mutations. The increased risk of leukemogenesis is certainly multifactorial and related to the pathophysiologic mechanisms of the clinical manifestations of SCD. Chronic hemolysis and secondary hemochromatosis may cause increased chronic inflammation, resulting in persistent marrow stress, which could potentially compromise the genomic stability of the hematopoietic stem cells generating genomic damage and somatic mutations over the course of SCD and its treatment, resulting in a clone that led to acute myeloid leukemia.
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Affiliation(s)
- Giovanna Cannas
- Internal Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5, place d'Arsonval, Lyon cedex 03, 69437, Lyon, France.
- Constitutive reference center: Major sickle cell syndromes, thalassemias and other rare pathologies of red blood cell and erythropoiesis, Edouard Herriot Hospital, Lyon, France.
| | - Solène Poutrel
- Internal Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5, place d'Arsonval, Lyon cedex 03, 69437, Lyon, France
- Constitutive reference center: Major sickle cell syndromes, thalassemias and other rare pathologies of red blood cell and erythropoiesis, Edouard Herriot Hospital, Lyon, France
| | - Maël Heiblig
- Hematology, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Hélène Labussière
- Hematology, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
| | | | - Xavier Thomas
- Constitutive reference center: Major sickle cell syndromes, thalassemias and other rare pathologies of red blood cell and erythropoiesis, Edouard Herriot Hospital, Lyon, France
| | - Arnaud Hot
- Internal Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5, place d'Arsonval, Lyon cedex 03, 69437, Lyon, France
- Constitutive reference center: Major sickle cell syndromes, thalassemias and other rare pathologies of red blood cell and erythropoiesis, Edouard Herriot Hospital, Lyon, France
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3
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Muzazu SGY, Chirwa M, Khatanga-Chihana S, Munyinda M, Simuyandi M. Sickle Cell Disease in Early Infancy: A Case Report. Pediatric Health Med Ther 2022; 13:377-383. [PMID: 36536766 PMCID: PMC9759007 DOI: 10.2147/phmt.s388147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/02/2022] [Indexed: 08/29/2023] Open
Abstract
Sickle cell disease (SCD) refers to a group of hereditary disorders that result in faulty hemoglobin carriage by the red blood cells. This paper discusses an atypical presentation of SCD in early infancy. Despite current literature suggesting protection by fetal hemoglobin in the first few months of life, we report a diagnosis of SCD at 2 months of age with severe symptoms requiring hospitalization. It is therefore important for clinicians to raise their clinical index of suspicion of SCD in children presenting with severe anemia even though they are less than 6 months old and do not present with classic dactylitis or pain syndromes. Expansion and sustained newborn screening programs for SCD in developing countries could help clinicians and parents plan for early treatment, appropriate prophylaxis, and improved management of SCD complications.
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Affiliation(s)
- Seke G Y Muzazu
- Enteric Disease and Vaccines Research Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Masuzyo Chirwa
- Enteric Disease and Vaccines Research Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Shalom Khatanga-Chihana
- Enteric Disease and Vaccines Research Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Masiliso Munyinda
- Enteric Disease and Vaccines Research Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Michelo Simuyandi
- Enteric Disease and Vaccines Research Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
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Barbetta A, Goldbeck C, Lim A, Martin SP, Kahn JA, Sheikh MR, Emamaullee J. Treatment and outcomes of hepatocellular carcinoma in patients with Sickle cell disease: a population-based study in the U.S. HPB (Oxford) 2022; 24:234-243. [PMID: 34294525 PMCID: PMC8733051 DOI: 10.1016/j.hpb.2021.06.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/27/2021] [Accepted: 06/21/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is a rare hemoglobinopathy which can result in chronic liver disease and cirrhosis. Patients with SCD have an increased risk of hematologic malignancy, but the prevalence of hepatocellular carcinoma (HCC) in this population is unknown. Herein, the association of SCD with HCC was examined using registry data. METHODS The SEER-Medicare database was queried to identify patients diagnosed with HCC between 2000 and 2015, and further stratified by SCD status. Propensity matching was performed to examine cancer-related survival and treatment outcomes. RESULTS Overall 56,934 patients with HCC were identified, including 81 patients with SCD. Patients with SCD more frequently had cirrhosis [48.1% (39/81) vs 23.5% (13,377/56,853), p < 0.01] yet presented with smaller tumors [<5 cm: 51.9% (42/81) vs 38.5% (21,898/56,853), p = 0.01]. After propensity matching, SCD was not associated with attenuated survival (aHR 0.73 95%CI 0.52-1.01). When stratified by treatment, patients with SCD had equivalent outcomes to chemotherapy (p = 0.65), TACE/TARE (p = 0.35), resection (p = 0.15) and transplantation (p = 0.67) when compared to non-SCD patients. CONCLUSION This study confirms that a subset of patients with SCD will develop HCC. Importantly, therapeutic options for HCC should not be limited by pre-existing SCD, and similar survival should be expected when compared to non-SCD patients.
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Affiliation(s)
- Arianna Barbetta
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, 1510 San Pablo St, Los Angeles, 90033, CA, USA
| | - Cameron Goldbeck
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, 1510 San Pablo St, Los Angeles, 90033, CA, USA
| | - Angelina Lim
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, 1510 San Pablo St, Los Angeles, 90033, CA, USA
| | - Sean P Martin
- Deparment of Surgery, UPMC Pinnacle, 111 S Front St, Harrisburg, 17101, PA, USA
| | - Jeffrey A Kahn
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, University of Southern California, 1510 San Pablo St, Los Angeles, 90033, CA, USA
| | - M Raashid Sheikh
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, 1510 San Pablo St, Los Angeles, 90033, CA, USA
| | - Juliet Emamaullee
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery, Department of Surgery, University of Southern California, 1510 San Pablo St, Los Angeles, 90033, CA, USA.
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Rodriguez A, Duez P, Dedeken L, Cotton F, Ferster A. Hydroxyurea (hydroxycarbamide) genotoxicity in pediatric patients with sickle cell disease. Pediatr Blood Cancer 2018. [PMID: 29512872 DOI: 10.1002/pbc.27022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hydroxyurea (HU) reduces the severity of sickle cell disease (SCD) in children; nevertheless, its long-term safety is an important concern. This paper evaluates HU genotoxicity at dose ≤ 30 mg/kg/day after over 2 years of treatment. PROCEDURE The study included 76 children: 32 SCD patients treated with HU, 27 SCD patients not treated with HU, and 17 unaffected children. HU patients were classified as good or poor responders according to their clinical response. Comet assay allows the comparison of DNA damage between both groups of patients and unaffected children. Maximal concentration (Cmax ) of HU in plasma was determined after drug administration. RESULTS Mean values of DNA in the comet tail were 5.13 ± 6.84 for unaffected children, 5.80 ± 7.78 for patients with SCD treated with HU, and 5.61 ± 6.91 for patients with SCD not treated with HU. Significant differences were observed between unaffected children and children with SCD. No difference was evident between comets from SCD patients treated and not treated with HU. In the case of HU, mean DNA in the comet tail was significantly lower in good responders than in poor responders: 5.54 ± 7.77 and 6.69 ± 8.43, respectively. Mean Cmax value on plasma was 39.08 ± 15.65 mg/l; N = 31. CONCLUSIONS SCD increases, slightly but significantly, DNA damage in lymphocytes from patients with SCD. Patients with SCD treated with HU do not present more nucleoid damage than patients with SCD not treated with HU. Good responders to the HU treatment have significantly less nucleoid damage than poor responders. HU treatment at ≤30 mg/kg/day does not expose patients to a genotoxic plasma concentration.
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Affiliation(s)
- Anar Rodriguez
- Laboratory of Biological and Medical Chemistry, Faculté de Phamacie, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Service of Clinical Chemistry, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB), Brussels, Belgium
| | - Pierre Duez
- Unit of Therapeutic Chemistry and Pharmacognosy, Faculté de Medicine et Pharmacie, Université de Mons (UMONS), Brussels, Belgium
| | - Laurence Dedeken
- Department of Hematology/Oncology, Hôpital Universitaire des Enfants "Reine Fabiola", Brussels, Belgium
| | - Frédéric Cotton
- Laboratory of Biological and Medical Chemistry, Faculté de Phamacie, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Service of Clinical Chemistry, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB), Brussels, Belgium
| | - Alina Ferster
- Department of Hematology/Oncology, Hôpital Universitaire des Enfants "Reine Fabiola", Brussels, Belgium
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Zhao Y, Bailey JA, Linden J, St. Pierre P, Cerny J, Vauthrin M, Greene M, Weinstein R. Automated red blood cell exchange in preparation for filgrastim mobilization of autologous peripheral blood hematopoietic progenitor cells in a patient with sickle cell anemia. J Clin Apher 2017; 33:431-435. [DOI: 10.1002/jca.21602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Yong Zhao
- Transfusion Medicine and Apheresis Service; UMass Memorial Medical Center; Worcester Massachusetts
- Division of Transfusion Medicine; UMass Memorial Medical Center; Worcester Massachusetts
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
- Department of Pathology; University of Massachusetts Medical School; Worcester Massachusetts
| | - Jeffrey A. Bailey
- Transfusion Medicine and Apheresis Service; UMass Memorial Medical Center; Worcester Massachusetts
- Division of Transfusion Medicine; UMass Memorial Medical Center; Worcester Massachusetts
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
- Department of Pathology; University of Massachusetts Medical School; Worcester Massachusetts
| | - Jeanne Linden
- Transfusion Medicine and Apheresis Service; UMass Memorial Medical Center; Worcester Massachusetts
| | - Patricia St. Pierre
- Transfusion Medicine and Apheresis Service; UMass Memorial Medical Center; Worcester Massachusetts
| | - Jan Cerny
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
- Division of Hematology/Oncology; UMass Memorial Medical Center; Worcester Massachusetts
| | - Michelle Vauthrin
- Transfusion Medicine and Apheresis Service; UMass Memorial Medical Center; Worcester Massachusetts
| | - Mindy Greene
- Transfusion Medicine and Apheresis Service; UMass Memorial Medical Center; Worcester Massachusetts
| | - Robert Weinstein
- Transfusion Medicine and Apheresis Service; UMass Memorial Medical Center; Worcester Massachusetts
- Division of Transfusion Medicine; UMass Memorial Medical Center; Worcester Massachusetts
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
- Department of Pathology; University of Massachusetts Medical School; Worcester Massachusetts
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Seminog OO, Ogunlaja OI, Yeates D, Goldacre MJ. Risk of individual malignant neoplasms in patients with sickle cell disease: English national record linkage study. J R Soc Med 2016; 109:303-9. [PMID: 27325377 PMCID: PMC4976723 DOI: 10.1177/0141076816651037] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Case reports suggest that there may be an increased risk of some cancers associated with sickle cell disease. However, population-based studies are scarce and there is no comprehensive enumeration of the risks across the whole range of site-specific cancers. Our aim was to provide this. DESIGN We used an English national dataset of linked statistical records of hospital admissions and deaths from 1999 to 2011 to undertake a retrospective cohort study. SETTING England. PARTICIPANTS Records of all hospital admissions in England with SCD or with conditions included in the control cohort. MAIN OUTCOME MEASURES Rate ratios were calculated comparing rates of cancer in a sickle cell disease cohort and a control cohort, confining the analyses to people whose ethnicity was recorded as Black. RESULTS Comparing the sickle cell disease cohort with the cohort without sickle cell disease, the rate ratio for all cancers combined was 2.1 (95% confidence interval 1.7-2.5). There were significantly high rate ratios for haematological malignancies, including Hodgkin's lymphoma (rate ratio 3.7, 1.5-8.4), non-Hodgkin's lymphoma (2.6, 1.3-4.8), multiple myeloma (5.5, 2.8-10.1), lymphoid leukaemia (3.3, 1.3-8.0) and myeloid leukaemia (10.0, 4.6-21.5). Four solid tumours showed elevated rate ratios: colon cancer (2.8, 1.2-5.5), non-melanoma skin cancer (4.4, 1.3-12.2), kidney cancer (5.4, 2.3-11.5) and thyroid cancer (5.1, 1.3-15.4). CONCLUSIONS The risk of some malignancies may be raised in patients with sickle cell disease. However, this study was based on administrative data without the scope to validate these against patients' full clinical records. Our findings need confirmation or refutation. If confirmed, work to elucidate, at the genetic and molecular level, why people with sickle cell disease have elevated risks of individual cancers might make contributions to the fundamental understanding of carcinogenesis.
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Affiliation(s)
- Olena O Seminog
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Oyindamola I Ogunlaja
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - David Yeates
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Michael J Goldacre
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
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Sanford K, Roseff SD, Anderson J, Chung HM, McPherson RA. Harvesting autologous stem cells from a patient with red blood cell abnormalities of β-thalassemia intermedia. Transfusion 2014; 54:1881-6. [PMID: 24527966 DOI: 10.1111/trf.12579] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 10/30/2013] [Accepted: 11/25/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Autologous stem cell transplants in patients with hemoglobinopathies are limited. Previous reports used granulocyte-colony-stimulating factor (G-CSF) for mobilization of stem cells; there are no reported cases undergoing plerixafor mobilization. We report such a patient, providing guidance for peripheral blood stem cells collection when aberrant red blood cells (RBCs) disrupt normal separation. STUDY DESIGN AND METHODS A patient with β-thalassemia intermedia and hereditary persistence of fetal hemoglobin presented for peripheral blood stem cell collection for autologous transplant for myeloma. He underwent splenectomy for anemia secondary to hemoglobinopathy and chemotherapy, ceasing RBC transfusions. The patient was mobilized using plerixafor after collection with G-CSF failed. RESULTS Collections were performed using an apheresis system, processing 24 L daily. Peripheral blood and apheresis product CD34 determinations were performed daily. On Day 1, the product yield was 0.04 × 10(6) CD34 cells/kg, less than expected based on white blood cell count and CD34-positive cells. Peripheral blood smear showed nucleated RBCs and RBC morphologic abnormalities. Changes in instrument variables were made after consultation with Terumo BCT to adjust for variable distribution of mononuclear and stem cells during centrifugation. Collecting stem cells at a deeper location and centrifuging faster improved collection, and a cumulative total of 4.40 × 10(6) CD34 cells/kg was achieved after four collections. The patient underwent tandem autologous transplantation and engrafted within 12 to 13 days of each transplant. CONCLUSIONS Adjustments in apheresis variables allowed successful collection of peripheral blood stem cells from a patient with RBC anomalies of β-thalassemia that interfered with standard stem cell harvesting.
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Affiliation(s)
- Kimberly Sanford
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
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Saito N, Nadgir RN, Flower EN, Sakai O. Clinical and Radiologic Manifestations of Sickle Cell Disease in the Head and Neck. Radiographics 2010; 30:1021-34. [DOI: 10.1148/rg.304095171] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Wilson NM, Espirito JL, Valero V, Pusztai L. Paclitaxel-induced sickle cell crisis. Am J Health Syst Pharm 2008; 65:1333-6. [DOI: 10.2146/ajhp070432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Nicole M. Wilson
- Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, and Clinical Pharmacy Specialist, Hematology/ Oncology, St. Vincent Hospital, Indianapolis; at the time of writing, she was Oncology Pharmacy Practice Resident, The University of Texas M. D. Anderson Cancer Center, Houston
| | - Janet L. Espirito
- Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center
| | - Lajos Pusztai
- Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center
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Tormey CA, Snyder EL, Cooper DL. Mobilization, collection, and transplantation of peripheral blood hematopoietic progenitor cells in a patient with multiple myeloma and hemoglobin SC disease. Transfusion 2008; 48:1930-3. [PMID: 18513256 DOI: 10.1111/j.1537-2995.2008.01777.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The use of granulocyte-colony-stimulating factor (G-CSF) for mobilization, collection, and transplantation of autologous hematopoietic progenitor cells (HPCs) in patients with hemoglobinopathies can be complicated by severe vasoocclusive crises. Erythrocytapheresis before G-CSF administration may help prevent these complications. To date, no cases regarding the safety and outcome of erythrocytapheresis followed by autologous high-dose G-CSF mobilization in hemoglobinopathy populations have been reported. STUDY DESIGN AND METHODS A patient with hemoglobin (Hb) SC disease and multiple myeloma underwent erythrocytapheresis followed by high-dose (16 microg/kg) G-CSF in preparation for HPC mobilization and collection. RESULTS Erythrocytapheresis reduced the patient's combined Hb S and C levels to less than 20 percent. Subsequent HPC mobilization and peripheral blood harvesting using high-dose G-CSF yielded approximately 9 x 10(6) CD34+ HPCs per kg over 3 days of collection. Mobilization and leukapheresis were completed without vasoocclusive complications. Two weeks after collection, and after myeloablative chemotherapy, 5.33 x 10(6) CD34+ HPCs per kg were infused to the patient; platelet and white cell engraftment occurred, respectively, on Days +9 and +10 posttransplant. The patient experienced no vasoocclusive complications in the posttransplant period. CONCLUSIONS The results of this case demonstrate that erythrocytapheresis before high-dose G-CSF HPC mobilization and collection appears to be an effective means for prevention of vasoocclusive crisis in patients with hemoglobinopathies undergoing autologous stem cell transplantation.
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Affiliation(s)
- Christopher A Tormey
- Department of Laboratory Medicine and Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
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12
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Abstract
There are reports of patients with sickle cell disease who developed hematological malignancies but the relationship between these malignancies and sickle cell disease (SCD) is not yet defined. The co-existence of a hematological malignancy with SCD poses certain challenges for the management of each condition. We describe a 7-year-old boy with sickle cell anemia who developed Hodgkin's lymphoma and the challenges of management. He presented with a 4-year history of bilateral neck swelling and a 2-month history of weight loss and high-grade fever. Histology of a lymph node biopsy was consistent with mixed cellularity Hodgkin's lymphoma. He was treated with five cycles of Cyclophosphamide, Vincristine, Procarbazine and Prednisolone (COPP) and had complete clinical response. Chemotherapy was associated with an increase in frequency of painful crises and complicated by septicaemia. Blood transfusion needs were minimal; apart from the transfusion preceding the first cycle of chemotherapy, there was no need for further transfusion. Myelosuppression was not a problem in the patient; he responded well to antibiotics during the two episodes of septicemia without the use of hemopoetic growth factor. Patients with sickle cell anaemia who develop Hodgkin's lymphoma can be successfully treated with chemotherapy along with supportive management for crises and infections.
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Affiliation(s)
- Biobele J Brown
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria.
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13
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Kamble RT, Tin-U CK, Carrum G. Successful mobilization and transplantation of filgrastim mobilized hematopoietic stem cells in sickle cell-hemoglobin C disease. Bone Marrow Transplant 2006; 37:1065-6. [PMID: 16708064 DOI: 10.1038/sj.bmt.1705376] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ferster A, Sariban E, Meuleman N. Malignancies in sickle cell disease patients treated with hydroxyurea. Br J Haematol 2003; 123:368-9. [PMID: 14531924 DOI: 10.1046/j.1365-2141.2003.04614.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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