1
|
Dovern E, Aydin M, Hazenberg MD, Tang MW, Suijk EM, Hoogendoorn GM, Van Tuijn CFJ, Kerkhoffs JL, Rutten CE, Zeerleder SS, de la Fuente J, Biemond BJ, Nur E. Azathioprine/hydroxyurea preconditioning prior to nonmyeloablative matched sibling donor hematopoietic stem cell transplantation in adults with sickle cell disease: A prospective observational cohort study. Am J Hematol 2024; 99:1523-1531. [PMID: 38733340 DOI: 10.1002/ajh.27360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/22/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024]
Abstract
Nonmyeloablative, matched sibling donor hematopoietic stem cell transplantation with alemtuzumab/total body irradiation (TBI) conditioning is a curative therapy with low toxicity for adults with sickle cell disease (SCD). However, relatively low donor chimerism levels and graft rejection remain important challenges. We hypothesized that adding azathioprine/hydroxyurea preconditioning will improve donor chimerism levels and reduce graft failure rate. In this prospective cohort study, we enrolled consecutive adult patients with SCD undergoing matched sibling donor transplantation at the Amsterdam UMC. Patients received azathioprine 150 mg/day and hydroxyurea 25 mg/kg/day for 3 months prior to alemtuzumab 1 mg/kg and 300 cGy TBI conditioning. Twenty patients with SCD (median age 26 years [range 19-49], 13 females) were transplanted. Median follow-up was 46.0 months (IQR 21.8-57.9). One-year overall survival and event-free survival (graft failure or death) were both 95% (95% confidence interval 86-100). Mean donor myeloid and T-cell chimerism 1-year post-transplant were 95.2% (SD ±10.6) and 67.3% (±15.3), respectively. One patient (5%) experienced graft failure without autologous regeneration, resulting in infections and death. All other patients had a corrected SCD phenotype and were able to discontinue sirolimus. Three patients were successfully treated with alemtuzumab (1 mg/kg) after the transplant because of declining donor chimerism and cytopenias to revert impending graft rejection. Toxicity was mostly related to sirolimus and alemtuzumab. One patient developed steroid-responsive grade II intestinal acute graft-versus-host disease. Collectively, preconditioning with azathioprine/hydroxyurea prior to nonmyeloablative matched sibling donor transplantation resulted in excellent event-free survival and robust donor T-cell chimerism, enabling the successful withdrawal of sirolimus. ClinicalTrials.gov: NCT05249452.
Collapse
Affiliation(s)
- Elisabeth Dovern
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Mesire Aydin
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Mette D Hazenberg
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Man Wai Tang
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Elisabeth M Suijk
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Gerianne M Hoogendoorn
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Charlotte F J Van Tuijn
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Caroline E Rutten
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Sacha S Zeerleder
- Department of Hematology, Division of Internal Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Josu de la Fuente
- Department of Paediatrics, St. Mary's Hospital, Imperial Healthcare NHS Trust, London, UK
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Bart J Biemond
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Erfan Nur
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Department of Blood Cell Research, Sanquin Research, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Rostami T, Rad S, Rostami MR, Mirhosseini SA, Alemi H, Khavandgar N, Janbabai G, Kiumarsi A, Kasaeian A, Mousavi SA. Hematopoietic Stem Cell Transplantation in Sickle Cell Disease: A Multidimentional Review. Cell Transplant 2024; 33:9636897241246351. [PMID: 38680015 PMCID: PMC11057353 DOI: 10.1177/09636897241246351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/06/2024] [Accepted: 03/17/2024] [Indexed: 05/01/2024] Open
Abstract
While exagamglogene autotemcel (Casgevy) and lovotibeglogene autotemcel (Lyfgenia) have been approved by the US Food and Drug Administration (FDA) as the first cell-based gene therapies for the treatment of patients 12 years of age and older with sickle cell disease (SCD), this treatment is not universally accessible. Allogeneic hematopoietic stem cell transplant (HSCT) has the potential to eradicate the symptoms of patients with SCD, but a significant obstacle in HSCT for SCD is the availability of suitable donors, particularly human leukocyte antigen (HLA)-matched related donors. Furthermore, individuals with SCD face an elevated risk of complications during stem cell transplantation due to SCD-related tissue damage, endothelial activation, and inflammation. Therefore, it is imperative to consider optimal conditioning regimens and investigate HSCT from alternative donors. This review encompasses information on the use of HSCT in patients with SCD, including the indications for HSCT, conditioning regimens, alternative donors, and posttransplant outcomes.
Collapse
Affiliation(s)
- Tahereh Rostami
- Hematologic Malignancies Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soroush Rad
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Rostami
- Hematologic Malignancies Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seied Amirhossein Mirhosseini
- Department of Internal Medicine, School of Medicine, Imam Ali Hospital, Alborz University of Medical Sciences, Tehran, Iran
| | - Hediyeh Alemi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Naghmeh Khavandgar
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasem Janbabai
- Hematologic Malignancies Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Kiumarsi
- Department of Pediatrics, School of Medicine, Childrens Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Clinical Research Development Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seied Asadollah Mousavi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Inam Z, Tisdale JF, Leonard A. Outcomes and long-term effects of hematopoietic stem cell transplant in sickle cell disease. Expert Rev Hematol 2023; 16:879-903. [PMID: 37800996 DOI: 10.1080/17474086.2023.2268271] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/04/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Hematopoietic stem cell transplant (HSCT) is the only readily available curative option for sickle cell disease (SCD). Cure rates following human leukocyte antigen (HLA)-matched related donor HSCT with myeloablative or non-myeloablative conditioning are >90%. Alternative donor sources, including haploidentical donor and autologous with gene therapy, expand donor options but are limited by inferior outcomes, limited data, and/or shorter follow-up and therefore remain experimental. AREAS COVERED Outcomes are improving with time, with donor type and conditioning regimens having the greatest impact on long-term complications. Patients with stable donor engraftment do not experience SCD-related symptoms and have stabilization or improvement of end-organ pathology; however, the long-term effects of curative strategies remain to be fully established and have significant implications in a patient's decision to seek therapy. This review covers currently published literature on HSCT outcomes, including organ-specific outcomes implicated in SCD, as well as long-term effects. EXPERT OPINION HSCT, both allogeneic and autologous gene therapy, in the SCD population reverses the sickle phenotype, prevents further organ damage, can resolve prior organ dysfunction in both pediatric and adult patients. Data support greater success with HSCT at a younger age, thus, curative therapies should be discussed early in the patient's life.
Collapse
Affiliation(s)
- Zaina Inam
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, DC, USA
| | - John F Tisdale
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexis Leonard
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| |
Collapse
|
4
|
How I prevent GVHD in high-risk patients: posttransplant cyclophosphamide and beyond. Blood 2023; 141:49-59. [PMID: 35405017 DOI: 10.1182/blood.2021015129] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 01/10/2023] Open
Abstract
Advances in conditioning, graft-versus-host disease (GVHD) prophylaxis and antimicrobial prophylaxis have improved the safety of allogeneic hematopoietic cell transplantation (HCT), leading to a substantial increase in the number of patients transplanted each year. This influx of patients along with progress in remission-inducing and posttransplant maintenance strategies for hematologic malignancies has led to new GVHD risk factors and high-risk groups: HLA-mismatched related (haplo) and unrelated (MMUD) donors; older recipient age; posttransplant maintenance; prior checkpoint inhibitor and autologous HCT exposure; and patients with benign hematologic disorders. Along with the changing transplant population, the field of HCT has dramatically shifted in the past decade because of the widespread adoption of posttransplantation cyclophosphamide (PTCy), which has increased the use of HLA-mismatched related donors to levels comparable to HLA-matched related donors. Its success has led investigators to explore PTCy's utility for HLA-matched HCT, where we predict it will be embraced as well. Additionally, combinations of promising new agents for GVHD prophylaxis such as abatacept and JAK inhibitors with PTCy inspire hope for an even safer transplant platform. Using 3 illustrative cases, we review our current approach to transplantation of patients at high risk of GVHD using our modern armamentarium.
Collapse
|
5
|
Bruce AAK, Guilcher GMT, Desai S, Truong TH, Leaker M, Alaazi DA, Pedersen SJV, Salami B. ADaPTS "(AD)olescents (P)ath through (T)ransplant (S)ickle cell disease". Health Qual Life Outcomes 2022; 20:118. [PMID: 35907865 PMCID: PMC9338650 DOI: 10.1186/s12955-022-02021-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Sickle cell disease is an inherited chronic hematological disorder with an average lifespan of fifty years. The human cost of sickle cell disease includes missed school days, occupational opportunities, social isolation, stigmatization, and psychological sequelae. Hematopoietic cell transplantation (HCT) is the only curative therapy available but comes with potential morbidity and mortality. Our study explores how quality of life (QoL) is affected from the perspective of an adolescent who has undergone a nonmyeloablative matched sibling donor HCT. Methods We employed multiple case study methodology with purposeful sampling by selecting information-rich cases. Data sources: 1) QoL inventories 2) patient interviews 3) parent interview 4) vital support interview 5) medical record analysis. Data analysis: Intra-case analysis by assembling evidence within a single case and then analyzing the differences within cases to create a rich case description. Next, a time series analysis was completed to track changes in patients’ QoL. We used multiple sources of data to compose a timeline and changes across time. Then, we employed pattern matching as an analytical technique allowing for examination of patterns across cases. Finally, we used cross case synthesis to review results of each case. Results Quality of life was reported across the physical, social and psychological domains for 5 participants. All had sickle cell HgSS genotype, 80% were male and 80% were born outside of Canada. Physical domain: pre-transplant, 100% of patients experienced pain, and the majority suffered from fatigue, insomnia, and fevers resulting in hospitalizations. Afterwards, participants reported improved physical wellbeing. Social domain: pre-transplant, QoL was poor characterized by stigma, social isolation, and parental absenteeism. Post-HSCT adolescents gained social acceptance in areas that had stigmatized and excluded them. They were able to participate freely in activities with peers and their social life vastly improved. Psychological pre-transplant life experiences were overshadowed by psychological stress. The majority commented that their future was bleak and may lead to premature death. Afterwards adolescents described a crisis free life with positive psychological outcomes. Conclusions Adolescents with sickle cell disease who undertook HCT demonstrated improved QoL one year post transplant with regard to physical, social and psychological well-being.
Collapse
Affiliation(s)
- Aisha A K Bruce
- Division of Pediatric Hematology and Oncology, 3-467 Edmonton Clinic Health Academy (ECHA), Department of Pediatrics, Faculty of Medicine, University of Alberta, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada. .,Stollery Children's Hospital, Alberta Health Services, Edmonton, AB, Canada.
| | - Gregory M T Guilcher
- Section of Pediatric Oncology/Cellular Therapy, Alberta Children's Hospital, Departments of Oncology and Pediatrics, Cumming School of Medicine, Calgary, AB, Canada
| | - Sunil Desai
- Division of Pediatric Hematology and Oncology, 3-467 Edmonton Clinic Health Academy (ECHA), Department of Pediatrics, Faculty of Medicine, University of Alberta, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada.,Stollery Children's Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Tony H Truong
- Section of Pediatric Oncology/Cellular Therapy, Alberta Children's Hospital, Departments of Oncology and Pediatrics, Cumming School of Medicine, Calgary, AB, Canada
| | - Michael Leaker
- Section of Pediatric Oncology/Cellular Therapy, Alberta Children's Hospital, Departments of Oncology and Pediatrics, Cumming School of Medicine, Calgary, AB, Canada
| | | | - Sasia J V Pedersen
- Division of Pediatric Hematology and Oncology, 3-467 Edmonton Clinic Health Academy (ECHA), Department of Pediatrics, Faculty of Medicine, University of Alberta, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Bukola Salami
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
6
|
Loggetto S, Veríssimo M, Darrigo-Junior L, Simões R, Bernardo W, Braga J. Guidelines on sickle cell disease: secondary stroke prevention in children and adolescents. Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular guidelines project: Associação Médica Brasileira - 2022. Hematol Transfus Cell Ther 2022; 44:246-255. [PMID: 35305940 PMCID: PMC9123578 DOI: 10.1016/j.htct.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 11/02/2022] Open
|
7
|
de Azevedo JTC, Costa TCDM, Lima KC, Maciel TT, Palma PVB, Darrigo-Júnior LG, Setanni Grecco CE, Stracieri ABPL, Elias JB, Pieroni F, Guerino-Cunha RL, Pinto ACS, De Santis GC, Covas DT, Hermine O, Simões BP, Oliveira MC, Malmegrim KCR. Long-Term Effects of Allogeneic Hematopoietic Stem Cell Transplantation on Systemic Inflammation in Sickle Cell Disease Patients. Front Immunol 2021; 12:774442. [PMID: 34956203 PMCID: PMC8696202 DOI: 10.3389/fimmu.2021.774442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only currently available curative treatment for sickle cell disease (SCD). However, the effects of HSCT on SCD pathophysiology are poorly elucidated. Here, we assessed red blood cell (RBC) adhesiveness, intensity of hemolysis, vascular tone markers and systemic inflammation, in SCD patients treated with allogeneic HSCT. Thirty-two SCD patients were evaluated before and on long-term follow-up after HSCT. Overall survival was 94% with no severe (grade III-IV) graft-vs-host disease and a 22% rejection rate (graft failure). Hematological parameters, reticulocyte counts, and levels of lactate dehydrogenase (LDH), endothelin-1 and VCAM-1 normalized in SCD patients post-HSCT. Expression of adhesion molecules on reticulocytes and RBC was lower in patients with sustained engraftment. Levels of IL-18, IL-15 and LDH were higher in patients that developed graft failure. Increased levels of plasma pro-inflammatory cytokines, mainly TNF-α, were found in SCD patients long-term after transplantation. SCD patients with sustained engraftment after allo-HSCT showed decreased reticulocyte counts and adhesiveness, diminished hemolysis, and lower levels of vascular tonus markers. Nevertheless, systemic inflammation persists for at least five years after transplantation, indicating that allo-HSCT does not equally affect all aspects of SCD pathophysiology.
Collapse
Affiliation(s)
- Júlia Teixeira Cottas de Azevedo
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Graduate Program in Basic and Applied Immunology of the Ribeirão Preto Medicinal School, University of São Paulo, Ribeirão Preto, Brazil
| | - Thalita Cristina de Mello Costa
- Bone Marrow Transplantation and Cellular Therapy Unit, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Keli Cristina Lima
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Graduate Program in Bioscience and Biotechnology, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Thiago Trovati Maciel
- Institut national de la santé et de la recherche médicale (INSERM) Unité mixte de recherche (UMR) 1163, Centre national de la recherche scientifique (CNRS) Equipe de Recherche Labellisée (ERL) 8254, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Imagine Institute, Paris, France.,Imagine Institute, Université Paris Descartes, Sorbonne Paris-Cité et Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Patrícia Vianna Bonini Palma
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Luiz Guilherme Darrigo-Júnior
- Bone Marrow Transplantation and Cellular Therapy Unit, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Ana Beatriz P L Stracieri
- Bone Marrow Transplantation and Cellular Therapy Unit, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Juliana Bernardes Elias
- Bone Marrow Transplantation and Cellular Therapy Unit, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Fabiano Pieroni
- Bone Marrow Transplantation and Cellular Therapy Unit, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Renato Luiz Guerino-Cunha
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Department of Medical Imaging, Hematology, and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Cristina Silva Pinto
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Gil Cunha De Santis
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Dimas Tadeu Covas
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Department of Medical Imaging, Hematology, and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Olivier Hermine
- Institut national de la santé et de la recherche médicale (INSERM) Unité mixte de recherche (UMR) 1163, Centre national de la recherche scientifique (CNRS) Equipe de Recherche Labellisée (ERL) 8254, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Imagine Institute, Paris, France.,Imagine Institute, Université Paris Descartes, Sorbonne Paris-Cité et Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Belinda Pinto Simões
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Maria Carolina Oliveira
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Department of Internal Medicine, Division of Clinical Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Kelen Cristina Ribeiro Malmegrim
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Department of Clinical Analysis, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| |
Collapse
|
8
|
Loggetto SR, Veríssimo MPDA, Darrigo-Junior LG, Simões RDS, Bernardo WM, Braga JAP. Guidelines on sickle cell disease: primary stroke prevention in children and adolescents. Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular Guidelines project: Associação Médica Brasileira - 2021. Hematol Transfus Cell Ther 2021; 44:85-94. [PMID: 34857507 PMCID: PMC8885378 DOI: 10.1016/j.htct.2021.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sandra Regina Loggetto
- Hospital Infantil Sabará, São Paulo, SP, Brazil; Grupo Gestor de Serviços de Hematologia (GSH), São Paulo, SP, Brazil; Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil.
| | - Mônica Pinheiro de Almeida Veríssimo
- Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Centro Infantil de Investigações Hematológicas Dr. Domingos A. Boldrini, Campinas, SP, Brazil
| | - Luiz Guilherme Darrigo-Junior
- Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP/USP), Ribeirão Preto, SP, Brazil
| | - Ricardo Dos Santos Simões
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil; Associação Médica Brasileira (AMB), São Paulo, SP, Brazil
| | - Wanderley Marques Bernardo
- Associação Médica Brasileira (AMB), São Paulo, SP, Brazil; Faculdade de Medicina da Universidade de São Paulo (FM USP), São Paulo, SP, Brazil
| | - Josefina Aparecida Pellegrini Braga
- Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM UNIFESP), São Paulo, SP, Brazil
| |
Collapse
|
9
|
Carpenter JL, Nickel RS, Webb J, Khademian Z, Speller-Brown B, Majumdar S, Darbari DS, Campbell A, Zhang A, Abraham A. Low Rates of Cerebral Infarction after Hematopoietic Stem Cell Transplantation in Patients with Sickle Cell Disease at High Risk for Stroke. Transplant Cell Ther 2021; 27:1018.e1-1018.e9. [PMID: 34530179 DOI: 10.1016/j.jtct.2021.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/16/2021] [Accepted: 08/30/2021] [Indexed: 01/15/2023]
Abstract
Hematopoietic stem cell transplantation (HSCT) can be curative for sickle cell disease (SCD). SCD patients with cerebrovascular disease are often referred for HSCT. The objective of this study was to describe neurologic outcomes after HSCT in patients with pre-existing SCD and cerebrovascular comorbidity. Patients with SCD treated with HSCT at a single center between 1996 and 2019 were identified. Patients with cerebral ischemia and/or vasculopathy before undergoing HSCT were included. Patients with graft failure were excluded. The cohort was divided into 3 groups: symptomatic stroke, vasculopathy without symptomatic stroke, and isolated silent cerebral infarction (SCI). Magnetic resonance imaging/angiography and neurologic assessments pre- and post-HSCT were analyzed to assess outcomes. In a cohort of 44 patients, there were 25 with symptomatic infarction, 10 with vasculopathy, and 9 with isolated SCI. Post-HSCT ischemic injury (2 symptomatic strokes, 2 SCIs) was identified in 4 patients, all with previous symptomatic infarction. Within this group (n = 25), the post-HSCT incidence of subsequent symptomatic infarction was 1.6 events/100 patient-years, and SCIs occurred at a rate of 2.2 events/100 patient-years. No patient had progression of vasculopathy post-HSCT. Our data show a low incidence of new ischemic injury after successful HSCT for SCD. Patients with a history of both symptomatic stroke and vasculopathy are at greatest risk for post-HSCT ischemic injury.
Collapse
Affiliation(s)
- Jessica L Carpenter
- Department of Pediatrics and Neurology, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Robert S Nickel
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jennifer Webb
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Zarir Khademian
- Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Barbara Speller-Brown
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Suvankar Majumdar
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Deepika S Darbari
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Andrew Campbell
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Anqing Zhang
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Allistair Abraham
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| |
Collapse
|
10
|
Cimpeanu E, Poplawska M, Jimenez BC, Dutta D, Lim SH. Allogeneic hematopoietic stem cell transplant for sickle cell disease: The why, who, and what. Blood Rev 2021; 50:100868. [PMID: 34332804 DOI: 10.1016/j.blre.2021.100868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/01/2022]
Abstract
Allogeneic hematopoietic stem cell transplants (allo-HSCTs) from matched-related donors (MRDs), mismatched-related donors (MMRDs), and matched-unrelated donors (MUDs) are increasingly being used to treat sickle cell disease (SCD) in both pediatric and adult patients. The overall results have been extremely encouraging, especially if a MRD is available and the transplant being performed before the age of 13. Although there is a general consensus that patients with high-risk SCD, even in adults and irrespective of donor characteristics, should be offered allo-HSCT, the debates on optimal patient selection and timing of transplant have yet to be resolved. Unlike patients with hematologic malignancies, there are also a number of clinical issues that require to be addressed in patients with SCD undergoing allo-HSCT. In this review, we will discuss the reasons allo-HSCT should be offered more widely to patients with SCD, the challenges facing physicians in patient selection and timing of transplant, and the awareness of and solutions to prevent the complications that are unique or more common in SCD undergoing allo-HSCT.
Collapse
Affiliation(s)
- Emanuela Cimpeanu
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, United States
| | - Maria Poplawska
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, United States
| | - Brian Campbell Jimenez
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, United States
| | - Dibyendu Dutta
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, United States
| | - Seah H Lim
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, United States.
| |
Collapse
|
11
|
Ordóñez J, Del Cañizo A, Beléndez C, García-Morín M, Pérez-Egido L, Fanjul M, García-Casillas MA, Cerdá J, Peláez D, Bardón E, de Agustín JC, Cela E. Complications of Central Venous Access Devices in Patients With Sickle Cell Disease and Thalassemia Major. J Pediatr Hematol Oncol 2021; 43:e655-e660. [PMID: 33093353 DOI: 10.1097/mph.0000000000001972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/15/2020] [Indexed: 01/19/2023]
Abstract
Pediatric patients with sickle cell disease and thalassemia major present clinical characteristics that could lead to a higher incidence of central venous access devices-associated complications (CVAD-C). With the objective of analyzing the safety of the use of CVAD in these patients, a retrospective review including all pediatric patients with these pathologies who required the implantation of a CVAD between 2004 and 2019 was performed. In all, 54 patients with 100 CVAD (65 totally implantable venous access port with subcutaneous reservoir, 35 single-lumen or double-lumen partially tunneled catheter) were included. During 60,410 days at risk of suffering a CVAD-C, 55 complications (complication rate [CR]/1000 catheter-days at risk=0.91) were reported in 46 CVAD: 19 mechanicals (CR=0.32), 32 infectious (CR=0.53), and 4 thrombotic complications (CR=0.066). Incidence of mechanical and infectious complications was significantly higher in double-lumen partially tunneled catheter than in totally implantable venous access port with subcutaneous reservoir (P<0.001). Lower age at insertion was related with a higher incidence of any complication (odds ratio=0.88/y, P=0.02). Patients who required a stem cell transplantation (31 patients and 65 CVAD) had no significant higher incidences of CVAD-C. In conclusion, our study supports the safety of using CVAD in these patients, with a low incidence of infectious, thrombotic, and mechanical complications.
Collapse
Affiliation(s)
| | | | - Cristina Beléndez
- Unit of Pediatric Oncology and Hematology, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain
| | - Marina García-Morín
- Unit of Pediatric Oncology and Hematology, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain
| | | | | | | | | | | | - Eduardo Bardón
- Unit of Pediatric Oncology and Hematology, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain
| | | | - Elena Cela
- Unit of Pediatric Oncology and Hematology, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain
| |
Collapse
|
12
|
Ganesh B, Rajakumar T, Acharya SK, Kaur H. Sickle cell anemia/sickle cell disease and pregnancy outcomes among ethnic tribes in India: an integrative mini-review. J Matern Fetal Neonatal Med 2021; 35:4897-4904. [PMID: 33563075 DOI: 10.1080/14767058.2021.1872536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: To evaluate the studies which have reported the prevalence of maternal complications and outcomes for women with SCA/SCD. Healthy populations make a healthy community and improve the future for mankind. Pregnant women are an essential segment of humanity as they bear the fetus and supply nutrition for their development throughout the gestational period. Their health status and disease conditions also play a vital role in deciding the future of the offspring.Materials and methods: The Mesh terms: "Haemoglobinopathies" + "Sickle cell anemia" + "Sickle cell disease" + "Ethnic tribes" + "Pregnancy outcomes" + "India" were used to search the literature available from public databases such as "PubMed", "PubMed Central" "Google Scholar", "Science Direct" and "Scopus" and the same is checked for removing repetitions. The data was extracted and collected literature was thoroughly analysed. SCD/SCA is a commonly prevalent hereditary hemoglobinopathy disease and is related to augmented risk factors and premature mortality.Results: SCD severely affects pregnancy, which leads to the elevated occurrence of perinatal and maternal outcomes such as pre-eclampsia, eclampsia, abortions, intrauterine growth retardation (IUGR), etc., and sufficient care during the pregnancy guarantees an improved outcome. Due to the best health care conveniences, availability of drugs such as hydroxyurea, antibiotic prophylaxis, and vaccination, the life expectancy of SCD patients has greatly improved in recent times though directly related to the access and services available at the healthcare facilities for the needy and poor. Moreover, the latest innovations in the fields of prenatal screening and preimplantation genetic diagnosis (PGD), facilitate partners suffering from SCA/SCD to have a healthy child. There are no available studies on the prevalence of SCA/SCD in pregnant women among ethnic tribal populations from India.Conclusion: This review article is focused on the effects of SCA/SCD on pregnancy outcomes, the consistent follow-up, routine check-ups and successful management of complications throughout pregnancy, the various diagnostic methods toward preventive methods, curative and management therapeutic strategies and also defines the perinatal and maternal outcomes in the ethnic tribal populations of India.
Collapse
Affiliation(s)
| | - Thangarasu Rajakumar
- Laboratory Division, ICMR-National Institute of Epidemiology (ICMR-NIE), Chennai, India
| | | | - Harpreet Kaur
- Indian Council of Medical Research (ICMR), Ansari Nagar, India
| |
Collapse
|
13
|
Bachmeier I, Blecha C, Föll J, Wolff D, Jägle H. [Maculopathy in sickle cell disease]. Ophthalmologe 2021; 118:1013-1023. [PMID: 33502544 PMCID: PMC8492597 DOI: 10.1007/s00347-020-01319-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/17/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
Hintergrund Die Sichelzellerkrankung (SZE) ist eine hereditäre Hämoglobinopathie, die durch rezidivierende vasookklusive Episoden zur Mikrozirkulationsstörung verschiedener Organsysteme mit teils letalem Ausgang führt. Bei der okulären Manifestation der SZE ist am bekanntesten die periphere Sichelzellretinopathie (SZR). Unabhängig davon kann es bereits früh im Krankheitsverlauf zur Sichelzellmakulopathie (SZM) kommen. Methoden Review der internationalen und deutschsprachigen Literatur zur okulären Beteiligung bei SZE mit Fokus auf die SZR und SZM sowie Überblick über aktuelle systemische Therapieansätze bei SZE anlässlich der Vorstellung zweier Patienten mit HbSS-SZE. Ergebnis und Schlussfolgerung Im Gegensatz zur SZR ist die SZM mit temporaler Verdünnung der inneren Netzhautschichten erst in den letzten 5 Jahren mit der Einführung von SD-OCT und OCTA vermehrt in die Literatur eingegangen. Unabhängig vom Vorliegen einer SZR kann es immerhin bei etwa der Hälfte der Patienten bereits früh im Krankheitsverlauf zu einer SZM kommen. Das Krankheitsbild wird auch in Deutschland durch den Fortschritt der systemischen Therapiemöglichkeiten und aufgrund von Migration präsenter werden. Durch Wissen um diese Komplikation der SZE kann eine frühzeitige Diagnosestellung erfolgen und unnötige Diagnostik vermieden werden.
Collapse
Affiliation(s)
- Isabel Bachmeier
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - Christiane Blecha
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Jürgen Föll
- Abteilung für Pädiatrische Hämatologie, Onkologie und Stammzelltransplantation, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Daniel Wolff
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Herbert Jägle
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| |
Collapse
|
14
|
Benítez-Carabante MI, Beléndez C, González-Vicent M, Alonso L, Uría-Oficialdegui ML, Torrent M, Pérez-Hurtado JM, Fuster JL, Cela E, Díaz-de-Heredia C. Matched sibling donor stem cell transplantation for sickle cell disease: Results from the Spanish group for bone marrow transplantation in children. Eur J Haematol 2021; 106:408-416. [PMID: 33296531 DOI: 10.1111/ejh.13566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The prevalence of sickle cell disease (SCD) in Spain is markedly inferior compared with other European and Mediterranean countries. However, the diagnosis of new patients with SCD is expected to increase. In this multicenter retrospective study, we analyze the hematopoietic stem cell transplantation (HSCT) results obtained in Spain. METHODS Forty-five patients who underwent a matched sibling donor (MSD) HSCT between 1999 and 2018 were included. Primary endpoint was event-free survival (EFS), and secondary endpoints included acute and chronic graft-versus-host disease (GvHD) and overall survival (OS). RESULTS Bone marrow was the most frequent stem cell source (93.3%). Most patients received a conditioning regimen based on busulfan and cyclophosphamide (69%). Cumulative incidence of grade III-IV acute GvHD and chronic GvHD was 6.8% (95% CI: 2.3%-20.1%) and 5.4% (95% CI: 1.38%-19.9%), respectively. EFS and overall survival (OS) at 3 years post-HSCT were 89.4% (95% CI: 73.9%-95.9%) and 92.1% (95% CI: 77.2%-97.4%), respectively. All patients aged ≤ 5 presented 100% EFS and OS. CONCLUSIONS An early referral to HSCT centers should be proposed early in life, before severe complications occur. MSD HSCT should be considered a curative option for all patients aged ≤ 5 years and for older pediatric patients who present complications derived from the disease.
Collapse
Affiliation(s)
- María Isabel Benítez-Carabante
- Department of Pediatric Hematology and Oncology, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Cristina Beléndez
- Department of Pediatric Hematology and Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marta González-Vicent
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Laura Alonso
- Department of Pediatric Hematology and Oncology, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - María Luz Uría-Oficialdegui
- Department of Pediatric Hematology and Oncology, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Monserrat Torrent
- Department of Pediatric Hematology and Oncology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | | | - José Luis Fuster
- Department of Pediatric Hematology and Oncology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Elena Cela
- Department of Pediatric Hematology and Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Díaz-de-Heredia
- Department of Pediatric Hematology and Oncology, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | | |
Collapse
|
15
|
Goal-Oriented Monitoring of Cyclosporine Is Effective for Graft-versus-Host Disease Prevention after Hematopoietic Stem Cell Transplantation in Sickle Cell Disease and Thalassemia Major. Biol Blood Marrow Transplant 2020; 26:2285-2291. [DOI: 10.1016/j.bbmt.2020.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 11/21/2022]
|
16
|
Abstract
Hemoglobinopathies are the most common single-gene diseases and are estimated to affect millions of people worldwide. Thalassemia and sickle cell disease are the most prevalent diseases of this group. Today, despite the decreasing number of newborns diagnosed with a hemoglobinopathy, it remains an important health problem for many countries. Although regular red blood cell (RBC) transfusions, advanced iron chelation, and supportive therapy alternatives have improved life expectancy, allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative option for patients with hemoglobinopathies to prevent irreversible organ damage. Modern transplantation approaches and careful posttransplantation follow-up of patients have improved survival outcomes, and HSCT has now been performed in several patients with hemoglobinopathies worldwide. Considering current experiences, hematopoietic stem cell transplantation is recommended in cases of β-thalassemia (β-thal) in the presence of a matched family or unrelated donor, without secondary organ damage due to transfusion. In patients with sickle cell anemia, transplantation indications include transfusion dependence and cases of secondary organ damage. Recently, gene therapy as a possible treatment option has yielded promising results, though it is not in routine clinical use at its current stage.
Collapse
Affiliation(s)
- M Akif Yesilipek
- Department of Pediatric Hematology and Pediatric Stem Cell Transplantation Unit, Medicalpark Antalya Hospital, Antalya, Turkey
| |
Collapse
|
17
|
Oringanje C, Nemecek E, Oniyangi O. Hematopoietic stem cell transplantation for people with sickle cell disease. Cochrane Database Syst Rev 2020; 7:CD007001. [PMID: 32617981 PMCID: PMC7390490 DOI: 10.1002/14651858.cd007001.pub5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Sickle cell disease is a genetic disorder involving a defect in the red blood cells due to its sickled hemoglobin. The main therapeutic interventions include preventive and supportive measures. Hematopoietic stem cell transplantations are carried out with the aim of replacing the defective cells and their progenitors (hematopoietic (i.e. blood forming) stem cells) in order to correct the disorder. This is an update of a previously published review. OBJECTIVES To determine whether stem cell transplantation can improve survival and prevent symptoms and complications associated with sickle cell disease. To examine the risks of stem cell transplantation against the potential long-term gain for people with sickle cell disease. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Group's Haemoglobinopathies Trials Register complied from electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (updated each new issue of the Cochrane Library) and quarterly searches of MEDLINE. We also searched trial registries for ongoing trials up to April 2020. Date of the most recent search of the Group's Haemoglobinopathies Trials Register: 09 December 2019. SELECTION CRITERIA Randomized controlled and quasi-randomized trials that compared any method of stem cell transplantation with either each other or with any of the preventive or supportive interventions (e.g. periodic blood transfusion, use of hydroxyurea, antibiotics, pain relievers, supplemental oxygen) in people with sickle cell disease irrespective of the type of sickle cell disease, gender and setting. DATA COLLECTION AND ANALYSIS No trials were eligible for inclusion in the review. MAIN RESULTS We identified 12 potentially-eligible trials by the searches; we excluded 11 of these and the remaining trial is an ongoing trial that may be eligible for inclusion in a future version of the review. AUTHORS' CONCLUSIONS Reports on the use of hematopoietic stem cell transplantation improving survival and preventing symptoms and complications associated with sickle cell disease are currently limited to observational and other less robust studies. We did not find any eligible randomized controlled trials assessing the benefit or risk of hematopoietic stem cell transplantations. However, there is an ongoing quasi-randomized trial comparing hematopoietic stem cell transplantation with standard care, Thus, this systematic review identifies the need for a multicentre randomized controlled trial assessing the benefits and possible risks of hematopoietic stem cell transplantations comparing sickle status and severity of disease in people with sickle cell disease.
Collapse
Affiliation(s)
- Chioma Oringanje
- GIDP Entomology and Insect Science, University of Tucson, Tucson, Arizona, USA
| | - Eneida Nemecek
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA
| | | |
Collapse
|
18
|
de Azevedo JTC, Malmegrim KCR. Immune mechanisms involved in sickle cell disease pathogenesis: current knowledge and perspectives. Immunol Lett 2020; 224:1-11. [PMID: 32437728 DOI: 10.1016/j.imlet.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/02/2020] [Accepted: 04/18/2020] [Indexed: 12/18/2022]
Abstract
Sickle cell disease (SCD) is caused by a single point mutation in the β-chain of the hemoglobin gene that results in the replacement of glutamic acid with valine in the hemoglobin protein. However, recent studies have demonstrated that alterations in several other genes, especially immune related genes, may be associated with complications of SCD. In fact, higher chronic inflammatory status is related to more severe clinical symptoms in SCD patients, suggesting crucial roles of the immune system in SCD physiopathology. Nevertheless, although participation of innate immune cells in SCD pathogenesis has been broadly and extensively described, little is known about the roles of the adaptive immune system in this disease. In addition, the influence of treatments on the immune system of SCD patients and their complications (such as alloimmunization) are not yet completely understood. Thus, we reviewed the current knowledge about the immune mechanisms involved in SCD pathogenesis. We suggest recommendations for future studies to allow for a broader understanding of SCD pathogenesis, helping in the development of new therapies and improvement in the life quality and expectancy of patients.
Collapse
Affiliation(s)
- Júlia Teixeira Cottas de Azevedo
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Kelen Cristina Ribeiro Malmegrim
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Clinical, Toxicological and Bromatological Analysis, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
| |
Collapse
|
19
|
Oevermann L, Sodani P. Status quo of allogeneic stem cell transplantation for patients with sickle cell disease using matched unrelated donors. Hematol Oncol Stem Cell Ther 2020; 13:116-119. [PMID: 32202244 DOI: 10.1016/j.hemonc.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022] Open
Abstract
This mini review is based on an oral presentation reflecting the current status quo of allogeneic hematopoietic stem cell transplantation (HSCT) for patients with sickle cell disease (SCD) using matched unrelated donors (MUDs) presented at the EBMT Sickle Disease Meeting held in Regensburg, Germany, in May 2019. Although the clinical trial landscape for MUD HSCT in patients with SCD is limited to date, some attempts to improve patient outcome in terms of overall survival and event-free survival have been made recently, including optimization of conditioning regimens and prevention of engraftment failure as well as graft-versus-host disease. The results achieved by these approaches are summarized in this review and are still unsatisfactory. Whether new haploidentical transplantation protocols will achieve superior results and are able to replace MUD HSCT for patients with SCD remains to be elucidated.
Collapse
Affiliation(s)
- L Oevermann
- Department of Pediatric Oncology & Hematology, Charité University Medicine, Berlin, Germany
| | - Pietro Sodani
- Department of Pediatric Oncology & Hematology, Charité University Medicine, Berlin, Germany.
| |
Collapse
|
20
|
Foell J, Kleinschmidt K, Jakob M, Troeger A, Corbacioglu S. Alternative donor: αß/CD19 T-cell-depleted haploidentical hematopoietic stem cell transplantation for sickle cell disease. Hematol Oncol Stem Cell Ther 2020; 13:98-105. [PMID: 32202248 DOI: 10.1016/j.hemonc.2019.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 12/28/2019] [Indexed: 10/24/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited disorder; despite significant improvements in supportive care, SCD continues to cause substantial morbidity, mortality, and reduced life expectancy. Allogeneic hematopoietic stem cell transplantation (HSCT) is currently the only widely available curative therapy for SCD, which is offered as a standard of care for patients with a matched sibling donor (MSD). Donor availability is limited to a minority of patients. Thus, αβ/CD3-depleted haploidentical HSCT, as an efficient means for depletion of graft-versus-host disease (GvHD)-mediating T cells, can be offered as an alternative curative therapy, particularly for nonmalignant diseases such as SCD. Out of 38 patients with advanced stage SCD, 25 were transplanted with CD3/CD19- or T-cell receptor αβ/CD19 T-cell-depleted peripheral stem cell grafts (T-haplo-HSCT group), whereas 13 transplanted from MSD (MSD group); both groups received an almost identical conditioning regimen. Engraftment was achieved in all. However, in the T-haplo-HSCT group, three patients succumbed to an uncontrolled cytomegalovirus pneumonitis, a macrophage activation syndrome, and a major blood group incompatibility with a late graft failure and multiorgan failure. The overall survival was 88% and 100% in T-haplo-HSCT and MSD groups, respectively. None of our patients developed a Glucksberg Grade III-IV acute GvHD. Four patients (16%) in the T-haplo-HSCT group and two patients (15%) in the MSD group developed a steroid-sensitive, mild-to-moderate chronic GvHD that resolved within 18 months posttransplant. These results are encouraging and demonstrate the feasibility, safety, and efficacy of T-haplo-HSCT in advanced stage SCD in children and adults, thus offering a curative alternative to majority of patients.
Collapse
Affiliation(s)
- Juergen Foell
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital of Regensburg, Regensburg, Germany
| | - Katharina Kleinschmidt
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital of Regensburg, Regensburg, Germany
| | - Marcus Jakob
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital of Regensburg, Regensburg, Germany
| | - Anja Troeger
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital of Regensburg, Regensburg, Germany
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital of Regensburg, Regensburg, Germany.
| |
Collapse
|
21
|
Allogeneic Hematopoietic Stem Cell Transplantation for Adults with Sickle Cell Disease. J Clin Med 2019; 8:jcm8101565. [PMID: 31581479 PMCID: PMC6832368 DOI: 10.3390/jcm8101565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 12/30/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited red blood cell disorder that leads to substantial morbidity and early mortality. Acute and chronic SCD-related complications increase with older age, and therapies are urgently needed to treat adults. Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative therapy, but has been used less frequently in adults compared to children. This is, in part, due to (1) greater chronic organ damage, limiting tolerability to myeloablative conditioning regimens, (2) a higher rate of HSCT-related complications in adults versus children with SCD, and (3) limited coverage by public and private health insurance. Newer approaches using nonmyeloablative and reduced-intensity conditioning HSCT regimens have demonstrated better safety and tolerability, with high rates of stable engraftment in SCD adults. This review will focus on the impacts of HSCT, using more contemporary approaches to SCD-related complications in adults.
Collapse
|
22
|
Fertility preservation in patients with hematologic malignancies and recipients of hematopoietic cell transplants. Blood 2019; 134:746-760. [PMID: 31292116 DOI: 10.1182/blood.2018846790] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 05/30/2019] [Indexed: 02/07/2023] Open
Abstract
Patients with hematologic malignancies and those undergoing hematopoietic cell transplantation (HCT) face a complex set of challenges when considering options for fertility preservation (FP). There are no standard options for prepubertal children, and women with hematologic malignancies may not be eligible for standard FP options. Fortunately, initial therapies for most blood cancers are not highly gonadotoxic, affording an important opportunity for postremission counseling and referrals to fertility specialists. These patients face a high risk of relapse, and many will be referred for autologous or allogeneic HCT, which carries an extremely high risk of infertility. The expanding indications for HCT to include benign hematologic disorders as well as autoimmune diseases mandate that all hematologists are familiar with these risks. Oncofertility researchers are continually pushing the boundaries of what may be possible for our patients; in the meantime, communication and shared decision-making between hematologists and patients, as well as program-building, education, and outreach are essential to ensure that these patients, many of whom will be cured, maintain all of their options for a fulfilling life after intensive therapy.
Collapse
|
23
|
Broglie L, Fretham C, Al-Seraihy A, George B, Kurtzberg J, Loren A, MacMillan M, Martinez C, Davies SM, Pasquini MC. Pulmonary Complications in Pediatric and Adolescent Patients Following Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:2024-2030. [PMID: 31201861 DOI: 10.1016/j.bbmt.2019.06.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/19/2019] [Accepted: 06/03/2019] [Indexed: 01/19/2023]
Abstract
Pulmonary complications after hematopoietic cell transplantation (HCT) can lead to significant morbidity and mortality. Limited evaluation of the true incidence of these complications in children and subsequent outcomes of these complications have not been evaluated recently. In April 2018, the National Heart, Lung, and Blood Institute; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; and the National Cancer Institute cosponsored a meeting of experts to describe the status of pulmonary complications in children after HCT, identify critical gaps in knowledge, and explore avenues for research to advance care and optimize outcomes. The Center for International Blood and Marrow Transplant Research was used to evaluate the cumulative incidence of pulmonary complications in children and their respective survival. Of the 5022 children included in this analysis who received allogeneic HCT from 2010 to 2016, 606 developed pulmonary complications within the first year after HCT. Pneumonitis occurred in 388 patients, 125 patients developed pulmonary hemorrhage, and 200 patients had lung graft-versus-host disease (GVHD). For those developing pulmonary complications within 1 year, overall survival 100 days after diagnosis of pulmonary complications was 49% (95% confidence interval [CI], 43% to 54%) for patients with pneumonitis, 23% (95% CI, 16% to 31%) in patients with pulmonary hemorrhage, and 87% (95% CI, 81% to 91%) in patients with pulmonary GVHD. This study demonstrates the approximate incidence of these complications, as well as their significant effects on survival, and can serve as a baseline for future research.
Collapse
Affiliation(s)
- Larisa Broglie
- Department of pediatrics, Columbia University Medical Center, New York, New York
| | - Caitrin Fretham
- National Marrow Donor Program/Be the Match, CIBMTR (Center for International Blood and Marrow Transplant Research), Minneapolis, Minnesota
| | - Amal Al-Seraihy
- Department of pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Biju George
- Department of hematology, Christian Medical College, Vellore, India
| | - Joanne Kurtzberg
- Division of Pediatric-Blood & Marrow Transplantation, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina; Carolinas Cord Blood Bank, Durham, North Carolina
| | - Alison Loren
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Margaret MacMillan
- Blood and Marrow Transplant Program-Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Caridad Martinez
- Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Stella M Davies
- Department of pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Marcelo C Pasquini
- Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, Wisconsin.
| |
Collapse
|
24
|
Toward dual hematopoietic stem-cell transplantation and solid-organ transplantation for sickle-cell disease. Blood Adv 2019. [PMID: 29535106 DOI: 10.1182/bloodadvances.2017012500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sickle-cell disease (SCD) leads to recurrent vaso-occlusive crises, chronic end-organ damage, and resultant physical, psychological, and social disabilities. Although hematopoietic stem-cell transplantation (HSCT) is potentially curative for SCD, this procedure is associated with well-recognized morbidity and mortality and thus is ideally offered only to patients at high risk of significant complications. However, it is difficult to identify patients at high risk before significant complications have occurred, and once patients experience significant organ damage, they are considered poor candidates for HSCT. In turn, patients who have experienced long-term organ toxicity from SCD such as renal or liver failure may be candidates for solid-organ transplantation (SOT); however, the transplanted organs are at risk of damage by the original disease. Thus, dual HSCT and organ transplantation could simultaneously replace the failing organ and eliminate the underlying disease process. Advances in HSCT conditioning such as reduced-intensity regimens and alternative donor selection may expand both the feasibility of and potential donor pool for transplantation. This review summarizes the current state of HSCT and organ transplantation in SCD and discusses future directions and the clinical feasibility of dual HSCT/SOT.
Collapse
|
25
|
Haploidentical Bone Marrow Transplantation with Post-Transplantation Cyclophosphamide Plus Thiotepa Improves Donor Engraftment in Patients with Sickle Cell Anemia: Results of an International Learning Collaborative. Biol Blood Marrow Transplant 2018; 25:1197-1209. [PMID: 30500440 DOI: 10.1016/j.bbmt.2018.11.027] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/24/2018] [Indexed: 12/19/2022]
Abstract
Curative therapy for individuals with severe sickle cell disease (SCD) who lack an HLA-identical sibling donor has been frustratingly elusive. In with the goal of improving engraftment while minimizing transplantation-related morbidity, a multi-institutional learning collaborative was developed in the context of a Phase II clinical trial of nonmyeloablative, related HLA-haploidentical (haplo) bone marrow transplantation (BMT) with post-transplantation cyclophosphamide. All eligible participants had hemoglobin SS, and 89% (16 of 18) had an identifiable donor. The median patient age was 20.9 years (IQR, 12.1 to 26.0 years), and the most common indication for transplantation was overt stroke (in 69%; 11 of 16). In the first 3 patients, the conditioning regimen consisted of antithymocyte globulin, fludarabine, cyclophosphamide, and low-dose total body irradiation. Graft-versus-host disease (GVHD) prophylaxis included post-transplantation cyclophosphamide, mycophenolate mofetil, and sirolimus. Primary graft rejection occurred in 2 of the 3 patients (67%), which triggered the study-stopping rule. To reduce graft rejection risk, thiotepa was added to the conditioning regimen, and then 15 patients (including 2 with previous graft rejection) underwent haplo-BMT with this thiotepa-augmented conditioning regimen. At a median follow-up of 13.3 months (interquartile range [IQR], 3.8 to 23.1 months), 93% (14 of 15) had >95% stable donor engraftment at 6 months, with 100% overall survival. The median time to neutrophil engraftment (>500) was 22 days (IQR, 19 to 27 days), and that for platelet engraftment (>50 x 109/L) was 28 days (IQR, 27 days to not reached). Two patients had grade III-IV acute GVHD, 1 patient had mild chronic GVHD, and 86% of patients (6 of 7) were off immunosuppression therapy by 1-year post-transplantation. Our data suggest that haplo-BMT with post-transplantation cyclophosphamide and thiotepa improves donor engraftment without significantly increasing morbidity or mortality and could dramatically expand curative options for individuals with SCD.
Collapse
|
26
|
Leonard A, Tisdale J. Stem cell transplantation in sickle cell disease: therapeutic potential and challenges faced. Expert Rev Hematol 2018; 11:547-565. [PMID: 29883237 PMCID: PMC8459571 DOI: 10.1080/17474086.2018.1486703] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/06/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) is the most common inherited hemoglobinopathy worldwide, and is a life-limiting disease with limited therapeutic options to reduce disease severity. Despite being a monogenic disorder, the clinical phenotypes of SCD are variable, with few reliable predictors of disease severity easily identifying patients where the benefits of curative therapy outweigh the risks. Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative option, though significant advances in gene therapy raise the promise for additional curative methods. Areas covered: Allogeneic transplantation in SCD has evolved and improved over the last two decades, now offering a standard of care curative option using a human leukocyte antigen (HLA)-matched sibling donor. Many of the seminal transplantation studies are reviewed here, demonstrating how initial failures and successes have influenced and led to current HSCT strategies. Such strategies aim to overcome setbacks and limitations, and focus on conditioning regimens, immune suppression methods, the use alternative donor sources, and gene therapy approaches. Expert commentary: SCD is a curable disease. Each dedicated effort to refine transplantation methods, expand the donor pool, and bring gene therapy models to fruition will make enormous impacts reducing disease burden and improving outcomes and quality of life for patients with SCD.
Collapse
Affiliation(s)
- Alexis Leonard
- Molecular and Clinical Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, MD, USA
- Center for Cancer and Blood Disorders, Children’s National Health System, Washington, DC, USA
| | - John Tisdale
- Molecular and Clinical Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, MD, USA
| |
Collapse
|
27
|
Hematopoietic stem cell transplantation for adult sickle cell disease in the era of universal donor availibility. Bone Marrow Transplant 2018; 53:1390-1400. [DOI: 10.1038/s41409-018-0193-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/13/2018] [Accepted: 03/28/2018] [Indexed: 12/13/2022]
|
28
|
Abstract
BACKGROUND Sickle cell disease causes significant morbidity and mortality and affects the economic and healthcare status of many countries. Yet historically, the disease has not had commensurate outlays of funds that have been aimed at research and development of drugs and treatment procedures for other diseases. METHODS This review examines several treatment modalities and new drugs developed since the late 1990s that have been used to improve outcomes for patients with sickle cell disease. RESULTS Targeted therapies based upon the pathophysiologic mechanisms of sickle cell disease that result in organ dysfunction and painful episodes include hydroxyurea, L-glutamine, crizanlizumab, and other drugs that are currently on the market or are on the verge of becoming available. These agents have the potential to improve survival and quality of life for individuals with sickle cell disease. Also discussed is stem cell transplantation that, to date, is the only curative approach for this disease, as well as the current status of gene therapy. CONCLUSION These examples demonstrate how the current knowledge of sickle cell disease pathophysiology and treatment approaches intersect. Although interest in sickle cell research has blossomed, many more clinical trials need to be initiated and subjected to more strenuous examination and analysis than have been used in the past.
Collapse
Affiliation(s)
- Renée V. Gardner
- Department of Pediatrics, Louisiana State University Health Sciences Center, Children’s Hospital of New Orleans, New Orleans, LA
| |
Collapse
|
29
|
The case for HLA-identical sibling hematopoietic stem cell transplantation in children with symptomatic sickle cell anemia. Blood Adv 2017; 1:2563-2567. [PMID: 29296908 DOI: 10.1182/bloodadvances.2017007708] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/02/2017] [Indexed: 12/11/2022] Open
Abstract
This article has a companion Counterpoint by DeBaun and Clayton.
Collapse
|
30
|
Abstract
PURPOSE OF REVIEW As the safety and availability of allogeneic hematopoietic stem cell transplantation (HSCT) have improved, this procedure is becoming a viable option for nonmalignant conditions such as sickle cell disease (SCD). There are very few treatment options available for SCD, and even with optimal care SCD patients still suffer from a myriad of comorbidities to multiple organ systems and have a decreased life span. In this review, we will summarize results from trials of HSCT for children or adults with SCD using a variety of graft sources as well as conditioning and graft-versus-host disease prophylaxis regimens, and discuss the unique challenges that arise in these patients. RECENT FINDINGS AlloHSCT for SCD has been performed on small numbers of patients at multiple centers around the world using several different transplant platforms, and early outcomes are encouraging. Overall survival is excellent, although graft failure remains a challenge. SUMMARY As alloHSCT becomes safer and more widely available, the procedure should be considered for patients with severe disease phenotypes in whom the potential benefits of transplantation outweigh the complications from the disease. AlloHSCT has been shown to reverse or at least halt the progression of end-organ damage secondary to SCD. More research is needed to understand the mechanisms underlying graft failure in SCD recipients, as well as to understand the biopsychosocial underpinnings of persistent pain in the posttransplant period to maximize the benefit from the transplant procedure.
Collapse
|
31
|
Ghafuri DL, Stimpson SJ, Day ME, James A, DeBaun MR, Sharma D. Fertility challenges for women with sickle cell disease. Expert Rev Hematol 2017; 10:891-901. [PMID: 28891355 DOI: 10.1080/17474086.2017.1367279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) represents one of the most common monogenic blood disorders worldwide, with an incidence of over 300,000 newborns affected per year. Reproductive challenges for men and women with SCD have been previously reviewed; however, evidence-based strategies to prevent and manage infertility and increase fecundity are lacking in women with SCD, which is one of the most important factors for quality of life. Areas covered: This review article summarizes the known risk factors for infertility, low fecundity, and premature menopause related to SCD. Expert commentary: Women with SCD have unique risk factors that may impact their ability to conceive, including chronic inflammation, oxidative stress, transfusion-related hemochromatosis, and ovarian sickling, causing ischemia and reperfusion injury to the ovary. Contraception is strongly recommended while on hydroxyurea therapy during reproductive years and discontinuing hydroxyurea for family planning and during pregnancy based on teratogenicity in animal studies. Hematopoietic stem cell transplantation (HSCT), the only curative therapy, sometimes involves conditioning regimens containing alkylating agents and total body irradiation that contribute to infertility and premature ovarian failure. Prior to HSCT or gene therapy, we strongly recommend referral to a reproductive endocrinologist to discuss fertility preservation and surrogacy options for all women with SCD.
Collapse
Affiliation(s)
- Djamila L Ghafuri
- a Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry-Matthew Walker Center for Excellence in Sickle Cell Disease , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Sarah-Jo Stimpson
- a Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry-Matthew Walker Center for Excellence in Sickle Cell Disease , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Melissa E Day
- a Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry-Matthew Walker Center for Excellence in Sickle Cell Disease , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Andra James
- b Department of Obstetrics & Gynecology , Duke University , Durham , NC , USA
| | - Michael R DeBaun
- a Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry-Matthew Walker Center for Excellence in Sickle Cell Disease , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Deva Sharma
- b Department of Obstetrics & Gynecology , Duke University , Durham , NC , USA
| |
Collapse
|
32
|
Lê PQ, Ferster A, Dedeken L, Vermylen C, Vanderfaeillie A, Rozen L, Heijmans C, Huybrechts S, Devalck C, Cotton F, Ketelslegers O, Dresse MF, Fils JF, Gulbis B. Neonatal screening improves sickle cell disease clinical outcome in Belgium. J Med Screen 2017; 25:57-63. [DOI: 10.1177/0969141317701166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To compare the outcomes of sickle cell disease patients diagnosed through neonatal screening with those who were not. Methods In an observational multicenter study in Belgium, 167 screened and 93 unscreened sickle cell disease patients were analyzed for a total of 1116 and 958 patient-years of follow-up, respectively. Both groups were compared with propensity score analysis, with patients matched on three covariates (gender, genotype, and central Africa origin). Bonferroni correction was applied for all comparisons. Results Kaplan–Meier estimates of survival without bacteremia were significantly higher in the screened group than the unscreened group (94.47%; [95% CI, 88.64–97.36%] versus 83.78% [95% CI, 72.27–90.42%]), p = 0.032. Non-significant differences between both groups were reported for survival without acute chest syndrome, acute anemia, cerebral complication, severe infection, and vaso-occlusive crisis. Significantly lower hospitalization rate and days per 100 patient-years were observed in the screened compared with the unscreened group (0.27 vs. 0.63 and 1.25 vs. 2.82, p = 0.0006 and <0.0001). Conclusion These data confirm the benefit of a neonatal screening programme in reducing bacteremia and hospitalization.
Collapse
Affiliation(s)
- Phu-Quoc Lê
- Hemato-Oncology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Alina Ferster
- Hemato-Oncology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Laurence Dedeken
- Hemato-Oncology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | | | - Anna Vanderfaeillie
- Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Laurence Rozen
- Laboratory of Hematology and Hemostasis, Centre Hospitalier Universitaire de Brugmann, Brussels, Belgium
| | - Catherine Heijmans
- Hemato-Oncology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Sophie Huybrechts
- Hemato-Oncology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Christine Devalck
- Hemato-Oncology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | | | | | | | | | | |
Collapse
|
33
|
Alternative donor hematopoietic stem cell transplantation for sickle cell disease. Blood Adv 2017; 1:1215-1223. [PMID: 29296761 DOI: 10.1182/bloodadvances.2017005462] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/15/2017] [Indexed: 11/20/2022] Open
Abstract
Most patients who could be cured of sickle cell disease (SCD) with stem cell transplantation do not have a matched sibling donor. Successful use of alternative donors, including mismatched family members, could provide a donor for almost all patients with SCD. The use of a reduced-intensity conditioning regimen may decrease late adverse effects. Ten patients with symptomatic SCD underwent CD34+ cell-selected, T-cell-depleted peripheral blood stem cell transplantation from a mismatched family member or unrelated donor. A reduced-intensity conditioning regimen including melphalan, thiotepa, fludarabine, and rabbit anti-thymocyte globulin was used. Patients were screened for a companion study for immune reconstitution that included a donor lymphocyte infusion given 30-42 days after transplant with intravenous methotrexate as graft-versus-host disease (GVHD) prophylaxis. Seven eligible patients were treated on the companion study. Nine of 10 patients are alive with a median follow-up of 49 months (range, 14-60 months). Surviving patients have stable donor hematopoietic engraftment (mean donor chimerism, 99.1% ± 0.7%). There were no sickle cell complications after transplant. Two patients had grade II-IV acute GVHD. One patient had chronic GVHD. Epstein-Barr virus-related posttransplant lymphoproliferative disorder (PTLD) occurred in 3 patients, and 1 patient died as a consequence of treatment of PTLD. Two-year overall survival was 90%, and event-free survival was 80%. A reduced-intensity conditioning regimen followed by CD34+ cell-selected, T-cell-depleted alternative donor peripheral blood stem cell transplantation achieved primary engraftment in all patients with a low incidence of GVHD, although PTLD was problematic. This trial was registered at clinicaltrials.gov as #NCT00968864.
Collapse
|
34
|
Rafii H, Bernaudin F, Rouard H, Vanneaux V, Ruggeri A, Cavazzana M, Gauthereau V, Stanislas A, Benkerrou M, De Montalembert M, Ferry C, Girot R, Arnaud C, Kamdem A, Gour J, Touboul C, Cras A, Kuentz M, Rieux C, Volt F, Cappelli B, Maio KT, Paviglianiti A, Kenzey C, Larghero J, Gluckman E. Family cord blood banking for sickle cell disease: a twenty-year experience in two dedicated public cord blood banks. Haematologica 2017; 102:976-983. [PMID: 28302713 PMCID: PMC5451329 DOI: 10.3324/haematol.2016.163055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/10/2017] [Indexed: 11/16/2022] Open
Abstract
Efforts to implement family cord blood banking have been developed in the past decades for siblings requiring stem cell transplantation for conditions such as sickle cell disease. However, public banks are faced with challenging decisions about the units to be stored, discarded, or used for other endeavors. We report here 20 years of experience in family cord blood banking for sickle cell disease in two dedicated public banks. Participants were pregnant women who had a previous child diagnosed with homozygous sickle cell disease. Participation was voluntary and free of charge. All mothers underwent mandatory serological screening. Cord blood units were collected in different hospitals, but processed and stored in two public banks. A total of 338 units were stored for 302 families. Median recipient age was six years (11 months-15 years). Median collected volume and total nucleated cell count were 91 mL (range 23-230) and 8.6×108 (range 0.7-75×108), respectively. Microbial contamination was observed in 3.5% (n=12), positive hepatitis B serology in 25% (n=84), and homozygous sickle cell disease in 11% (n=37) of the collections. Forty-four units were HLA-identical to the intended recipient, and 28 units were released for transplantation either alone (n=23) or in combination with the bone marrow from the same donor (n=5), reflecting a utilization rate of 8%. Engraftment rate was 96% with 100% survival. Family cord blood banking yields good quality units for sibling transplantation. More comprehensive banking based on close collaboration among banks, clinical and transplant teams is recommended to optimize the use of these units.
Collapse
Affiliation(s)
- Hanadi Rafii
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Françoise Bernaudin
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Paris XII University, Créteil, France
| | - Helene Rouard
- Cell Therapy Facility, EFS Ile de France, Créteil, France
| | - Valérie Vanneaux
- Cell Therapy Facility, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Biotherapy Clinical Investigation Center, Paris-Diderot University, Sorbonne Paris Cité, INSERM, F-75010, France
| | - Annalisa Ruggeri
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Marina Cavazzana
- Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, France
- Biotherapy Clinical Investigation Center, Groupe Hospitalier Universitaire Ouest, Assistance Publique-Hôpitaux de Paris, INSERM, France
- Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, France
| | - Valerie Gauthereau
- Fédération Parisienne Pour le Dépistage et la Prévention des Handicaps de l'Enfant (FPDPHE), Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Aurélie Stanislas
- Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, France
- Biotherapy Clinical Investigation Center, Groupe Hospitalier Universitaire Ouest, Assistance Publique-Hôpitaux de Paris, INSERM, France
| | - Malika Benkerrou
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Mariane De Montalembert
- Department of Pediatrics, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Christele Ferry
- Department of Stem Cell Transplantation, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Robert Girot
- Department of Hemato-Biology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Cecile Arnaud
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Paris XII University, Créteil, France
| | - Annie Kamdem
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Paris XII University, Créteil, France
| | - Joelle Gour
- Department of Gynecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Claudine Touboul
- Department of Gynecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Audrey Cras
- Cell Therapy Facility, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Biotherapy Clinical Investigation Center, Paris-Diderot University, Sorbonne Paris Cité, INSERM, F-75010, France
| | - Mathieu Kuentz
- Department of Hematology, Groupe Hospitalier Universitaire Henri-Mondor, Créteil, France
| | - Claire Rieux
- Unité d'Hémovigilance, Groupe Hospitalier Universitaire Henri-Mondor, Créteil, France
| | - Fernanda Volt
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Barbara Cappelli
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Karina T Maio
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Annalisa Paviglianiti
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Chantal Kenzey
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Jerome Larghero
- Cell Therapy Facility, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Biotherapy Clinical Investigation Center, Paris-Diderot University, Sorbonne Paris Cité, INSERM, F-75010, France
| | - Eliane Gluckman
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| |
Collapse
|
35
|
Simões BP, Pieroni F, Costa T, Barros GN, Darrigo G, Grecco CS, Bernardes JE, Moraes D, Stracieri ABL, Cunha R, Rodrigues MC. Allogenic bone narrow transplantation in sickle-cell diseases. Rev Assoc Med Bras (1992) 2017; 62 Suppl 1:16-22. [PMID: 27982320 DOI: 10.1590/1806-9282.62.suppl1.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sickle-cell diseases are the most common inherited hemoglobinopathies worldwide. Improvement in survival has been seen in the last decades with the introduction of careful screening and prevention of complications and the introduction of hydroxyurea. Stem-cell transplantation is currently the only curative option for these patients and has been indicated for patients with neurological events, repeated vaso-occlusive crisis, any organ damage or presence of red blood cell antibodies. Related bone-marrow or cord-blood transplant has shown an overall survival of more than 90% with a disease-free survival of 90% in 1,000 patients transplanted in the last decades. The use of unrelated donors unfortunately has not shown the same good results, but better typing methods and improved support may improve the outcome with this source of stem cells in the future. In Brazil, only recently stem cell transplant from related donors has been included in the procedures performed in the public health system. The use of related bone marrow or cord blood and a myeloablative conditioning regimen are considered standard of care for patients with sickle-cell diseases. Transplants with non-myeloablative regimens, unrelated donors or haploidentical donors should be performed only in controlled clinical trials.
Collapse
Affiliation(s)
| | - Fabiano Pieroni
- Transplantation Unit of Hospital das Clínicas, FMRP, USP, Brasil
| | - Thalita Costa
- Transplantation Unit of Hospital das Clínicas, FMRP, USP, Brasil
| | | | | | | | | | - Daniela Moraes
- Transplantation Unit of Hospital das Clínicas, FMRP, USP, Brasil
| | | | - Renato Cunha
- Transplantation Unit of Hospital das Clínicas, FMRP, USP, Brasil
| | | |
Collapse
|
36
|
Chaudhury S, Shenoy S. Sickle cell disease. CLINICAL MANUAL OF BLOOD AND BONE MARROW TRANSPLANTATION 2017:236-245. [DOI: 10.1002/9781119095491.ch27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
Affiliation(s)
- Sonali Chaudhury
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Shalini Shenoy
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Washington University School of Medicine; St. Louis Children's Hospital; St. Louis MO USA
| |
Collapse
|
37
|
Foell J, Pfirstinger B, Rehe K, Wolff D, Holler E, Corbacioglu S. Haploidentical stem cell transplantation with CD3+-/CD19+- depleted peripheral stem cells for patients with advanced stage sickle cell disease and no alternative donor: results of a pilot study. Bone Marrow Transplant 2017; 52:938-940. [DOI: 10.1038/bmt.2017.49] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
38
|
García Morin M, Cela E, Garrido C, Bardón Cancho E, Aguado del Hoyo A, Pascual C, Pérez-Corral A, Beléndez C. Bone marrow transplant in patients with sickle cell anaemia. Experience in one centre. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
39
|
García Morin M, Cela E, Garrido C, Bardón Cancho E, Aguado del Hoyo A, Pascual C, Pérez-Corral A, Beléndez C. Trasplante de médula ósea en pacientes con anemia falciforme. Experiencia en un centro. An Pediatr (Barc) 2017; 86:142-150. [DOI: 10.1016/j.anpedi.2016.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 03/20/2016] [Indexed: 11/30/2022] Open
|
40
|
Treosulfan-Based Conditioning Regimen in Sibling and Alternative Donor Hematopoietic Stem Cell Transplantation for Children with Sickle Cell Disease. Mediterr J Hematol Infect Dis 2017; 9:e2017014. [PMID: 28293402 PMCID: PMC5333731 DOI: 10.4084/mjhid.2017.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/12/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Lack of suitable donors and regimen related toxicity are major barriers for hematopoietic stem cell transplantation (HSCT) in patients with sickle cell disease (SCD). The aim of the study is the assessment of efficacy and toxicity of Treosulfan-based conditioning regimen for SCD also when alternative donors such as mismatched unrelated donor and haploidentical donor are employed. METHODS We report our single-center experience: 11 patients with SCD received HSCT with a Treosulfan/Thiotepa/Fludarabine/Anti-thymoglobulin conditioning regimen between 2010 and 2015. The donor was a matched sibling donor (n= 7), a haploidentical parent (n= 2), a matched unrelated donor (n= 1) or a mismatched unrelated donor (n=1). The haploidentical and mismatched unrelated donor grafts were manipulated by removing TCRαβ and CD19 positive cells. RESULTS All patients survived the procedure and achieved stable engraftment. Stable mixed chimerism was observed in 5/11 patients. Grade III-IV regimen related toxicity was limited to mucositis and no grade III-IV graft-versus-host disease (GvHD) occurred. No SCD manifestation was observed post transplant and cerebral vasculopathy improved in 3/5 evaluable patients. Organ function evaluation showed no pulmonary, cardiac or renal toxicity but gonadal failure occurred in 1/4 evaluable patients. CONCLUSION Our data suggest that Treosulfan is associated with low toxicity and may be employed also for unrelated and haploidentical donor HSCT.
Collapse
|
41
|
An Assessment of the Use, Perceived Benefits, and Outcomes of Ketamine in Sickle Cell Vaso-Occlusive Crisis in the United States. J Hosp Palliat Nurs 2017. [DOI: 10.1097/njh.0000000000000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
42
|
A trial of unrelated donor marrow transplantation for children with severe sickle cell disease. Blood 2016; 128:2561-2567. [PMID: 27625358 DOI: 10.1182/blood-2016-05-715870] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/06/2016] [Indexed: 01/29/2023] Open
Abstract
Children with sickle cell disease experience organ damage, impaired quality of life, and premature mortality. Allogeneic bone marrow transplant from an HLA-matched sibling can halt disease progression but is limited by donor availability. A Blood and Marrow Transplant Clinical Trials Network (BMT CTN) phase 2 trial conducted from 2008 to 2014 enrolled 30 children aged 4 to 19 years; 29 were eligible for evaluation. The primary objective was 1-year event-free survival (EFS) after HLA allele-matched (at HLA-A, -B, -C, and -DRB1 loci) unrelated donor transplant. The conditioning regimen included alemtuzumab, fludarabine, and melphalan. Graft-versus-host disease (GVHD) prophylaxis included calcineurin inhibitor, short-course methotrexate, and methylprednisolone. Transplant indications included stroke (n = 12), transcranial Doppler velocity >200 cm/s (n = 2), ≥3 vaso-occlusive pain crises per year (n = 12), or ≥2 acute chest syndrome episodes (n = 4) in the 2 years preceding enrollment. Median follow-up was 26 months (range, 12-62 months); graft rejection was 10%. The 1- and 2-year EFS rates were 76% and 69%, respectively. The corresponding rates for overall survival were 86% and 79%. The day 100 incidence rate of grade II-IV acute GVHD was 28%, and the 1-year incidence rate of chronic GVHD was 62%; 38% classified as extensive. There were 7 GVHD-related deaths. A 34% incidence of posterior reversible encephalopathy syndrome was noted in the first 6 months. Although the 1-year EFS met the prespecified target of ≥75%, this regimen cannot be considered sufficiently safe for widespread adoption without modifications to achieve more effective GVHD prophylaxis. The BMT CTN #0601 trial was registered at www.clinicaltrials.gov as #NCT00745420.
Collapse
|
43
|
Alsultan A, Jastaniah W, Al Afghani S, Al Bagshi MH, Nasserullah Z, Al-Suliman AM, Alabdulaali MK. Demands and challenges for patients with sickle-cell disease requiring hematopoietic stem cell transplantation in Saudi Arabia. Pediatr Transplant 2016; 20:831-5. [PMID: 27477851 DOI: 10.1111/petr.12767] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2016] [Indexed: 12/01/2022]
Abstract
Allogeneic HSCT is the only curative treatment for SCD. In this study, we estimated the number of Saudi patients with SCD who are candidates for HSCT. We used the presence of overt stroke, recurrent ACS, and frequent severe pain crisis as indications for HSCT. We calculated the frequencies of these complications among a Saudi SCD cohort of 376 patients with SCD, 250 from SW and 126 from Eastern (E) provinces. We found that 59 (23.6%) of SW patients were transplant candidates compared to 22 (17.4%) from E province. It is estimated that about 61 000 patients with SCD live in Saudi Arabia. Thus, the projected number of Saudi patients with SCD who are candidates for HSCT is 10 536 patients. Of those, 2148 are children. The burden of SCD on HSCT centers in Saudi Arabia is substantial and is difficult currently to meet the demand. We recommend recruiting/training more transplant physicians and nurses, expand current capacity of centers if feasible, and open new transplant centers to make HSCT a practical therapeutic option for patients with severe SCD in Saudi Arabia.
Collapse
Affiliation(s)
- Abdulrahman Alsultan
- Department of Pediatrics and Sickle Cell Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pediatric Hematology/Oncology, King Abdullah Specialist Children's Hospital, Riyadh, Saudi Arabia
| | - Wasil Jastaniah
- King Abdulaziz Medical City, Jeddah, Saudi Arabia.,Department of Pediatrics, College of Medicine, Umm alQura University, Makkah, Saudi Arabia
| | | | | | | | | | | |
Collapse
|
44
|
Iughetti L, Bigi E, Venturelli D. Novel insights in the management of sickle cell disease in childhood. World J Clin Pediatr 2016; 5:25-34. [PMID: 26862499 PMCID: PMC4737690 DOI: 10.5409/wjcp.v5.i1.25] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/13/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
Sickle cell disease (SCD) is a life-threatening genetic disorder characterized by chronic hemolytic anemia, vascular injury and multiorgan dysfunctions. Over the last few decades, there have been significant improvements in SCD management in Western countries, especially in pediatric population. An early onset of prophylaxis with Penicillin and a proper treatment of the infections have increased the overall survival in childhood. Nevertheless, management of painful episodes and prevention of organ damage are still challenging and more efforts are needed to better understand the mechanisms behind the development of chronic organ damages. Hydroxyurea (Hydroxycarbamide, HU), the only medication approved as a disease-modifying agent by the United States Food and Drug Administration and the European Medicines Agency, is usually under-used, especially in developing countries. Currently, hematopoietic stem-cell transplantation is considered the only curative option, although its use is limited by lack of donors and transplant-related toxicity. SCD symptoms are similar in children and adults, but complications and systemic organ damages increase with age, leading to early mortality worldwide. Experts in comprehensive care of young patients with SCD, especially those approaching the transition age to adulthood, are missing, leading people to rely on urgent care, increasing health care utilization costs and inappropriate treatments. It would be important to establish programs of comprehensive healthcare for patients with SCD from birth to adulthood, to improve their quality and expectancy of life.
Collapse
|
45
|
Abstract
PURPOSE OF REVIEW Hematopoietic cell transplantation (HCT) is a curative therapy for sickle cell disease (SCD) that is utilized very rarely because of limited allogeneic donor availability, limited healthcare resources needed to expand the treatment to regions in the world where most affected individuals reside, and by a view among SCD experts that HCT lacks the evidential rigor with short and long-term toxicity profiles that together might support its broader application. RECENT FINDINGS In this update, recent advances focused on donor selection, reduced toxicity preparation for HCT, and treatment of young adults will be presented. The current status of conventional bone marrow transplantation with a human leukocyte antigen-identical sibling donor is summarized. SUMMARY HCT for SCD is curative in almost all children who have a human leukocyte antigen-matched sibling donor. The future of this therapy will hinge on expanding the number of individuals who might be treated.
Collapse
Affiliation(s)
- Mark C Walters
- Jordan Family Director, Blood and Marrow Transplant Program, Division of Hematology/Oncology/BMT, UCSF Benioff Children's Hospital, Oakland, California, USA
| |
Collapse
|
46
|
Alfraih F, Aljurf M, Fitzhugh CD, Kassim AA. Alternative donor allogeneic hematopoietic cell transplantation for hemoglobinopathies. Semin Hematol 2016; 53:120-8. [PMID: 27000737 DOI: 10.1053/j.seminhematol.2016.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) offers a curative therapy for patients with hemoglobinopathies, mainly severe sickle cell disease (SCD) and thalassemia (TM). However, the applicability of HSCT has been limited mainly by donor availability, with a less than 25%-30% of eligible patients having human leukocyte antigen (HLA)-matched sibling donors. Previous outcomes using alternate donor options have been markedly inferior due to increased regimen-related toxicity, transplant-related mortality, graft failure, and graft-versus-host disease (GVHD). Advances in transplant technology, including high-resolution HLA typing, improved GVHD prophylactic approaches with tolerance induction, and better supportive care over the last decade, are addressing these historical challenges, resulting in increasing donor options. Herein, we review alternate donor HSCT approaches for severe SCD and TM using unrelated donors, umbilical cord blood units, or related haploidentical donors. Though this is an emerging field, early results are promising and in selected patients, this may be the preferred option to mitigate against the age-related morbidity and early mortality associated with these disorders.
Collapse
Affiliation(s)
- Feras Alfraih
- Adult Hematology and Hematopoietic Stem Cell Transplantation, King Faisal Hospital and Research Centre, Riyadh, Saudi Arabia.
| | - Mahmoud Aljurf
- Molecular and Clinical Hematology Branch, NHLBI, NIH, Bethesda, MD, USA
| | - Courtney D Fitzhugh
- Division of Hematology and Oncology, Department of Medicine and Vanderbilt- Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adetola A Kassim
- Division of Hematology and Oncology, Department of Medicine and Vanderbilt- Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
47
|
Kamath AF, McGraw MH, Israelite CL. Surgical management of osteonecrosis of the femoral head in patients with sickle cell disease. World J Orthop 2015; 6:776-782. [PMID: 26601059 PMCID: PMC4644865 DOI: 10.5312/wjo.v6.i10.776] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/12/2015] [Accepted: 09/18/2015] [Indexed: 02/06/2023] Open
Abstract
Sickle cell disease is a known risk factor for osteonecrosis of the hip. Necrosis within the femoral head may cause severe pain, functional limitations, and compromise quality of life in this patient population. Early stages of avascular necrosis of the hip may be managed surgically with core decompression with or without autologous bone grafting. Total hip arthroplasty is the mainstay of treatment of advanced stages of the disease in patients who have intractable pain and are medically fit to undergo the procedure. The management of hip pathology in sickle cell disease presents numerous medical and surgical challenges, and the careful perioperative management of patients is mandatory. Although there is an increased risk of medical and surgical complications in patients with sickle cell disease, total hip arthroplasty can provide substantial relief of pain and improvement of function in the appropriately selected patient.
Collapse
|
48
|
Lê PQ, Gulbis B, Dedeken L, Dupont S, Vanderfaeillie A, Heijmans C, Huybrechts S, Devalck C, Efira A, Dresse MF, Rozen L, Benghiat FS, Ferster A. Survival among children and adults with sickle cell disease in Belgium: Benefit from hydroxyurea treatment. Pediatr Blood Cancer 2015; 62:1956-61. [PMID: 26173735 DOI: 10.1002/pbc.25608] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/22/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the survival of patients with sickle cell disease (SCD) recorded in the Belgian SCD Registry and to assess the impact of disease-modifying treatments (DMT). METHOD The Registry created in 2008 included patients of eight centers. All available data in 2008 were retrospectively encoded in the database. After 2008 and until 2012, all data were recorded prospectively for already registered patients as well as newly diagnosed subjects. Data were registered from neonatal screening or from diagnosis (first contact) until last follow-up or death. Data included diagnosis, demography, and outcome data. RESULTS We collected data from 469 patients over a 5,110 patient years (PY) follow-up period. The global mortality rate was low (0.25/100 PY), although 13 patients died (2.8%) and was similar between children, adolescents (10-18 years), and young adults (P = 0.76). Out of the cohort, 185 patients received hydroxyurea at last follow-up (median duration of treatment: 10.3 years), 90 underwent hematopoietic stem cell transplantation (HSCT), 24 were chronically transfused, and 170 had never had any DMT. Hydroxyurea showed significant benefit on patients outcome as reflected by a lower mortality rate compared to transplanted individuals or people without DMT (0.14, 0.36, and 0.38 per 100 PY, respectively) and by higher Kaplan-Meier estimates of 15 year survival (99.4%) compared to HSCT (93.8%; P = 0.01) or no DMT groups (95.4%; P = 0.04). CONCLUSION SCD mortality in Belgium is low with no increase observed in young adults. Patients treated with hydroxyurea demonstrate a significant benefit in survival when compared to those without DMT or transplanted.
Collapse
Affiliation(s)
- Phu Quoc Lê
- Hemato-Oncology Unit, Hôpital Universitaire des Enfants Reine Fabiola, U.L.B., Brussels, Belgium
| | - Béatrice Gulbis
- Department of Clinical Chemistry, Hôpital Erasme, U.L.B., Brussels, Belgium
| | - Laurence Dedeken
- Hemato-Oncology Unit, Hôpital Universitaire des Enfants Reine Fabiola, U.L.B., Brussels, Belgium
| | - Sophie Dupont
- Hemato-Oncology Unit, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | | | - Catherine Heijmans
- Hemato-Oncology Unit, Hôpital Universitaire des Enfants Reine Fabiola, U.L.B., Brussels, Belgium.,Department of Pediatrics, Hôpital de Jolimont, La Louvière, Belgium
| | - Sophie Huybrechts
- Hemato-Oncology Unit, Hôpital Universitaire des Enfants Reine Fabiola, U.L.B., Brussels, Belgium
| | - Christine Devalck
- Hemato-Oncology Unit, Hôpital Universitaire des Enfants Reine Fabiola, U.L.B., Brussels, Belgium
| | - André Efira
- Hemato-Oncology Unit, Hôpital Universitaire Brugmann, U.L.B., Brussels, Belgium
| | | | - Laurence Rozen
- Laboratory of Hematology, CHU-Brugmann, Hôpital Universitaire des Enfants Reine Fabiola, U.L.B., Brussels, Belgium
| | | | - Alina Ferster
- Hemato-Oncology Unit, Hôpital Universitaire des Enfants Reine Fabiola, U.L.B., Brussels, Belgium
| |
Collapse
|
49
|
Saraf SL, Oh AL, Patel PR, Jalundhwala Y, Sweiss K, Koshy M, Campbell-Lee S, Gowhari M, Hassan J, Peace D, Quigley JG, Khan I, Molokie RE, Hsu LL, Mahmud N, Levinson DJ, Pickard AS, Garcia JGN, Gordeuk VR, Rondelli D. Nonmyeloablative Stem Cell Transplantation with Alemtuzumab/Low-Dose Irradiation to Cure and Improve the Quality of Life of Adults with Sickle Cell Disease. Biol Blood Marrow Transplant 2015; 22:441-8. [PMID: 26348889 DOI: 10.1016/j.bbmt.2015.08.036] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/31/2015] [Indexed: 11/25/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is rarely performed in adult patients with sickle cell disease (SCD). We utilized the chemotherapy-free, alemtuzumab/total body irradiation 300 cGy regimen with sirolimus as post-transplantation immunosuppression in 13 high-risk SCD adult patients between November 2011 and June 2014. Patients received matched related donor (MRD) granulocyte colony-stimulating factor-mobilized peripheral blood stem cells, including 2 cases that were ABO incompatible. Quality-of-life (QoL) measurements were performed at different time points after HSCT. All 13 patients initially engrafted. A stable mixed donor/recipient chimerism was maintained in 12 patients (92%), whereas 1 patient not compliant with sirolimus experienced secondary graft failure. With a median follow-up of 22 months (range, 12 to 44 months) there was no mortality, no acute or chronic graft-versus-host disease (GVHD), and no grades 3 or 4 extramedullary toxicities. At 1 year after transplantation, patients with stable donor chimerism have normalized hemoglobin concentrations and improved cardiopulmonary and QoL parameters including bodily pain, general health, and vitality. In 4 patients, sirolimus was stopped without rejection or SCD-related complications. These results underscore the successful use of a chemotherapy-free regimen in MRD HSCT for high-risk adult SCD patients and demonstrates a high cure rate, absence of GVHD or mortality, and improvement in QoL including the applicability of this regimen in ABO mismatched cases (NCT number 01499888).
Collapse
Affiliation(s)
- Santosh L Saraf
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois; University of Illinois Sickle Cell Center, Department of Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Illinois; University of Illinois Cancer Center, Chicago, Illinois.
| | - Annie L Oh
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Pritesh R Patel
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois; University of Illinois Cancer Center, Chicago, Illinois
| | - Yash Jalundhwala
- College of Pharmacy, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Karen Sweiss
- College of Pharmacy, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Matthew Koshy
- University of Illinois Cancer Center, Chicago, Illinois; Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Sally Campbell-Lee
- Institute for Transfusion Medicine & Department of Pathology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Michel Gowhari
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois; University of Illinois Sickle Cell Center, Department of Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
| | - Johara Hassan
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois; University of Illinois Sickle Cell Center, Department of Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
| | - David Peace
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois; University of Illinois Cancer Center, Chicago, Illinois
| | - John G Quigley
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois; University of Illinois Cancer Center, Chicago, Illinois
| | - Irum Khan
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois; University of Illinois Cancer Center, Chicago, Illinois
| | - Robert E Molokie
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois; University of Illinois Sickle Cell Center, Department of Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
| | - Lewis L Hsu
- University of Illinois Sickle Cell Center, Department of Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Illinois; Division of Pediatric Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Nadim Mahmud
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois; University of Illinois Cancer Center, Chicago, Illinois
| | - Dennis J Levinson
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - A Simon Pickard
- College of Pharmacy, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Joe G N Garcia
- Arizona Respiratory Center and Department of Medicine, University of Arizona, Tucson, Arizona
| | - Victor R Gordeuk
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois; University of Illinois Sickle Cell Center, Department of Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
| | - Damiano Rondelli
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois; University of Illinois Cancer Center, Chicago, Illinois; University of Illinois Center for Global Health, Chicago, Illinois.
| |
Collapse
|
50
|
Strocchio L, Romano M, Cefalo MG, Vinti L, Gaspari S, Locatelli F. Cord blood transplantation in children with hemoglobinopathies. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1076724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|