1
|
Damlaj M, Alahmari B, Alaskar A, Alhejazi A, Alsadi H, Ahmed M, Alanazi T, Ahmed R, Alharbi A, Shehabeddine I, Alzaidi A, Alkhuraisat S, Mahassnah I, Alquraan H, Ballili M, Alzahrani M. Favorable outcome of non-myeloablative allogeneic transplantation in adult patients with severe sickle cell disease: A single center experience of 200 patients. Am J Hematol 2024; 99:1023-1030. [PMID: 38488686 DOI: 10.1002/ajh.27295] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/02/2024] [Accepted: 03/06/2024] [Indexed: 05/16/2024]
Abstract
Allogeneic hematopoietic stem cell transplant (HSCT) for adults with severe sickle cell disease (SCD) is potentially curative but not commonly utilized therapy due to complications such as graft failure (GF) and organ toxicity. Herein, we are reporting our long-term outcome data of non-myeloablative (NMA) HSCT in adults with severe SCD with emphasis on factors predicting event free survival (EFS). Adults with severe SCD undergoing NMA match-related donor allogeneic HSCT from 2015 to 2021 with at least 12 months of follow-up were included. A total of 200 patients were included with a median age of 26 years (14-43) and 56% were male. The median infused CD34 dose was 13.7 (5.07-25.8), respectively. Median absolute neutrophil count engraftment was 19 (13-39) days with 51% of patients receiving GCSF to expedite recovery. A total of 17 patients experienced GF; 3 as primary and 14 as secondary within a median time of 204 days (40-905). A 76% successfully discontinued sirolimus at the last follow-up. Median follow-up for the cohort is 29.2 (2.1-71.4) months. Estimated 3-year EFS and OS were 88.2% (81.9-92.5) and 94.6% (89.2-97.3). At multivariable analysis, minor ABC incompatibility hazard ratio (HR) 4 (1.3-12.1; 0.014) and allo-antibody against non-ABO donor antigens HR 4.3 (1.3-14.1; 0.016) were significant for EFS. No clonal evolution or myeloid malignancies were seen. This largest single-center report of NMA HSCT in adults with severe SCD further delineated its feasibility, potential toxicities, and fertility outcomes. GF remains a major impediment and appears dependent on ABO matching and non-ABO antibodies.
Collapse
Affiliation(s)
- Moussab Damlaj
- Division of Hematology, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Blood and Cancer Research Unit, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Division of Hematology, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
- College of Medicine, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, UAE
| | - Bader Alahmari
- Division of Hematology, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Blood and Cancer Research Unit, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed Alaskar
- Division of Hematology, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Blood and Cancer Research Unit, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ayman Alhejazi
- Division of Hematology, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Blood and Cancer Research Unit, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Husam Alsadi
- Division of Hematology, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mazin Ahmed
- Division of Hematology, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Tahani Alanazi
- Division of Hematology, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Rasha Ahmed
- Division of Hematology, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Amani Alharbi
- Division of Hematology, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Inaam Shehabeddine
- Division of Hematology, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Afnan Alzaidi
- Division of Hematology, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Suha Alkhuraisat
- Division of Hematology, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Isam Mahassnah
- Division of Hematology, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hamza Alquraan
- Division of Hematology, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Maybelle Ballili
- Division of Hematology, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohsen Alzahrani
- Division of Hematology, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Blood and Cancer Research Unit, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| |
Collapse
|
2
|
Ahmed SG, Ibrahim UA. Non-S Sickling Hemoglobin Variants: Historical, Genetic, Diagnostic, and Clinical Perspectives. Oman Med J 2021; 36:e261. [PMID: 34113458 PMCID: PMC8170066 DOI: 10.5001/omj.2021.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 01/16/2020] [Indexed: 01/19/2023] Open
Abstract
Apart from hemoglobin-S (HbS), there are other Hb variants (non-S sickling Hb variants) that cause sickle cell disease. However, the profiles of these non-S sickling Hb variants have neither been collated nor harmonized. A literature search revealed 14 non-S sickling Hb variants (HbC-Harlem, HbC-Ziguinchor, HbS-Travis, HbS-Antilles, HbS-Providence, HbS-Oman, HbS-Cameroon, HbS-South End, Hb Jamaica Plain, HbC-Ndjamena, HbS-Clichy, HbS-San Martin, HbS-Wake, and HbS-São Paulo). Generally, the non-S sickling Hb variants are double mutants with the HbS mutation (GAG>GTG: βGlu6Val) and additional β-chain mutations. Consequently, non-S sickling Hb variants give positive solubility and sickling tests, but they differ from HbS with respect to stability, oxygen affinity, and electro-chromatographic characteristics. Similarities and discrepancies between HbS and non-S sickling Hb variants create diagnostic pitfalls that can only be resolved by elaborate electro-chromatographic and/or genetic tests. It is therefore imperative that tropical hematologists should have a thorough understanding of these atypical sickling Hb variants. Collated and harmonized appraisal of the non-S sickling Hb variants have not been previously undertaken. Hence, this paper aims to provide a comprehensive but concise historical, genetic, comparative, diagnostic, and clinical overview of non-S sickling Hb variants. The elaborate techniques often required for precise diagnosis of non-S sickling Hb variants are regrettably not readily available in low resource tropical countries, which paradoxically carry the heaviest burden of sickling disorders. We strongly recommend that tropical countries should upgrade their diagnostic laboratory facilities to avoid misdiagnosis of these atypical Hb mutants.
Collapse
Affiliation(s)
- Sagir G Ahmed
- Department of Hematology, Aminu Kano Teaching Hospital, Kano State, Nigeria
| | - Umma A Ibrahim
- Department of Pediatrics, Aminu Kano Teaching Hospital, Kano State, Nigeria
| |
Collapse
|
4
|
Dusetzina SB, Ellis S, Freedman RA, Conti RM, Winn AN, Chambers JD, Alexander GC, Huskamp HA, Keating NL. How Do Payers Respond to Regulatory Actions? The Case of Bevacizumab. J Oncol Pract 2015; 11:313-8. [PMID: 26060224 DOI: 10.1200/jop.2015.004218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In February 2008, the US Food and Drug Administration (FDA) granted accelerated approval for bevacizumab for metastatic breast cancer. After public hearings in July 2010, and June 2011, the FDA revoked this approved indication in November 2011, on the basis of additional evidence regarding its risk/benefit profile. The Centers for Medicare and Medicaid Services, local Medicare contractors, and commercial payers varied in their stated intentions to cover bevacizumab after FDA's regulatory actions. We examined payer-specific trends in bevacizumab use after the FDA's regulatory actions. METHODS We used outpatient medical claims compiled by IMS Health to evaluate trends in bevacizumab use for breast cancer for Medicare-insured and commercially insured patients (N = 102,906) using segmented regression. Given that Medicare coverage policies may vary across regional contractors, we estimated trends in bevacizumab use across 10 local coverage areas. In a sensitivity analysis, we estimated trends in bevacizumab use for breast cancer compared with trends in use for lung cancer using difference-in-differences models. RESULTS Among chemotherapy infusions for breast cancer, bevacizumab use decreased from 31% in July 2010, to 4% in September 2012. Use decreased by 11% among commercially insured and 13% among Medicare-insured patients after July 2010 (interaction P = .68) and continued to decline by 9% per month (interaction P = .61). We observed no contractor-level variation in bevacizumab use among Medicare beneficiaries. During the same period, bevacizumab use for lung cancer was stable. CONCLUSION Although insurers varied in public statements regarding coverage intentions, bevacizumab use declined similarly among all payers, suggesting that provider decision making, rather than payer-specific coverage policies, drove reductions.
Collapse
Affiliation(s)
- Stacie B Dusetzina
- UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill, Gillings School of Global Public Health; UNC Lineberger Comprehensive Cancer Center; Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC; University of Kansas School of Medicine, Kansas City, KS; Dana-Farber Cancer Institute; Tufts Medical Center Institute for Clinical Research and Health Policy Studies; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; University of Chicago, Chicago, IL; Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; and Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medicine, Baltimore, MD
| | - Shellie Ellis
- UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill, Gillings School of Global Public Health; UNC Lineberger Comprehensive Cancer Center; Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC; University of Kansas School of Medicine, Kansas City, KS; Dana-Farber Cancer Institute; Tufts Medical Center Institute for Clinical Research and Health Policy Studies; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; University of Chicago, Chicago, IL; Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; and Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medicine, Baltimore, MD
| | - Rachel A Freedman
- UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill, Gillings School of Global Public Health; UNC Lineberger Comprehensive Cancer Center; Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC; University of Kansas School of Medicine, Kansas City, KS; Dana-Farber Cancer Institute; Tufts Medical Center Institute for Clinical Research and Health Policy Studies; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; University of Chicago, Chicago, IL; Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; and Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medicine, Baltimore, MD
| | - Rena M Conti
- UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill, Gillings School of Global Public Health; UNC Lineberger Comprehensive Cancer Center; Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC; University of Kansas School of Medicine, Kansas City, KS; Dana-Farber Cancer Institute; Tufts Medical Center Institute for Clinical Research and Health Policy Studies; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; University of Chicago, Chicago, IL; Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; and Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medicine, Baltimore, MD
| | - Aaron N Winn
- UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill, Gillings School of Global Public Health; UNC Lineberger Comprehensive Cancer Center; Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC; University of Kansas School of Medicine, Kansas City, KS; Dana-Farber Cancer Institute; Tufts Medical Center Institute for Clinical Research and Health Policy Studies; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; University of Chicago, Chicago, IL; Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; and Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medicine, Baltimore, MD
| | - James D Chambers
- UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill, Gillings School of Global Public Health; UNC Lineberger Comprehensive Cancer Center; Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC; University of Kansas School of Medicine, Kansas City, KS; Dana-Farber Cancer Institute; Tufts Medical Center Institute for Clinical Research and Health Policy Studies; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; University of Chicago, Chicago, IL; Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; and Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medicine, Baltimore, MD
| | - G Caleb Alexander
- UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill, Gillings School of Global Public Health; UNC Lineberger Comprehensive Cancer Center; Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC; University of Kansas School of Medicine, Kansas City, KS; Dana-Farber Cancer Institute; Tufts Medical Center Institute for Clinical Research and Health Policy Studies; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; University of Chicago, Chicago, IL; Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; and Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medicine, Baltimore, MD
| | - Haiden A Huskamp
- UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill, Gillings School of Global Public Health; UNC Lineberger Comprehensive Cancer Center; Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC; University of Kansas School of Medicine, Kansas City, KS; Dana-Farber Cancer Institute; Tufts Medical Center Institute for Clinical Research and Health Policy Studies; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; University of Chicago, Chicago, IL; Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; and Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medicine, Baltimore, MD
| | - Nancy L Keating
- UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill, Gillings School of Global Public Health; UNC Lineberger Comprehensive Cancer Center; Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC; University of Kansas School of Medicine, Kansas City, KS; Dana-Farber Cancer Institute; Tufts Medical Center Institute for Clinical Research and Health Policy Studies; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; University of Chicago, Chicago, IL; Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; and Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medicine, Baltimore, MD
| |
Collapse
|
5
|
Adverse events in cancer patients with sickle cell trait or disease: case reports. Genet Med 2014; 17:237-41. [PMID: 25144888 DOI: 10.1038/gim.2014.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/07/2014] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Given the relatively high prevalence of sickle cell trait and disease among African Americans and established racial disparities in cancer outcomes, we reviewed the literature regarding adverse events in cancer patients with these hematologic genotypes. Erythrocyte sickling can result from extreme hypoxia and other physiologic stressors, as might occur during cancer therapy. Further, tumoral hypoxia, a poor prognostic and predictive factor, could lead to a cycle of local sickling and increased hypoxia. METHODS A search of PubMed produced 150 publications, most of which were excluded because of incidental relevance. Eleven case reports of patients diagnosed from 1993 to 2013 were reviewed. RESULTS Two reports of patients with sickle cell trait describe an abundance of sickled erythrocytes within tumors, and a third report describes sickling-related events requiring multiday hospitalization. Eight reports of patients with sickle cell disease delineated multiorgan failure, vaso-occlusive crises, and rapid renal deterioration. Hypothesized triggers are delayed clearance of anticancer agents attributable to baseline kidney damage, activation of vasoadherent neutrophils from treatment to counter chemotherapy-induced neutropenia, hypoxia from general anesthesia, and intratumoral hypoxia. CONCLUSION Clinical implications include pretreatment genotyping for prophylaxis, dose adjustment, and enhanced patient monitoring. With the current lack of high-quality evidence, however, the scope of poor outcomes remains unknown.
Collapse
|