ArticleMediterranean journal of hematology and infectious diseases2025
Hematopoietic Stem Cell Transplantation in Severe Pediatric Sickle Cell Disease: Outcome and long-term complications, Saudi experience at King Faisal Specialist Hospital, Riyadh, Saudi Arabia.
Article in Mediterranean journal of hematology and infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Hematopoietic stem transplantation (HSCT) from matched related donors (MRD) is offered as a curative therapeutic option in children with Sickle cell disease (SCD). Objective: We wanted to assess the outcome and long-term complications observed in children undergoing HSCT at a single transplant center in Saudi Arabia. Patients and Methods: One hundred and twenty-nine children were transplanted for severe Sickle cell disease (SCD) consecutively from 2006 to 2020 at our center. The main transplant indication was cerebral vasculopathy in 57 (43%), followed by the recurrent vaso-occlusive crisis (VOC) in 47 (36%). Median age at transplant was 9.1 years (range, 1.5-13.9 years). All patients received myeloablative conditioning with Busulfan, Cyclophosphamide, and Anti T-Lymphocyte Globulin (Grafalon®): BU/CY/ATG in 114 (88.4%), BU/CY in 13 (10%) and other in 2 (2%). Bone marrow was the main stem cell source in 123 (95%). Results: All patients showed granulocyte engraftment. Acute graft-versus-host-disease (aGVHD) and chronic GVHD were observed in 26 (20%) and 12 (9%) patients, respectively. At a median follow-up of 4.36 years (range, 0.13-15.5 years), 10-year overall survival (OS) and event-free survival (EFS) of 94% and 91% was observed. The OS and EFS were significantly better in patients receiving BU/CY/ATG when compared to BU/CY (OS: 97.4%±1.5%, vs. 76.2%±12.1 Conclusion: HSCT for children with sickle cell disease from fully matched siblings offers the best outcome using myeloablative conditioning. However, significant toxicities were observed secondary to myeloablative regimens, in particular long-term complications, which demands exploring the use of less toxic regimens.
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