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Publications

Journal Article Epublish

PubMed: 40375907 DOI: 10.4084/MJHID.2025.030

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.

Mediterr J Hematol Infect Dis 17(1):e2025030

Authors: Abdullah Al-Jefri, Fatema Al-Hashem, Khawar Siddiqui, Amal Al-Seraihy, Ali Al-Ahmari, Ibrahim Ghemlas, Awatif AlAnazi, Hawazen Al-Saedi, Saadiya Khan, Abdulrahman Al-Musa, Mahasen Saleh, Mouhab Ayas

Affiliations

  • Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
  • Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.

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 P=0.003 and EFS: 94.7%±2.1% vs. 76.2%±12.1%, P=0.019).

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.

MeSH

Cells, Microscopy, Electron, Scanning Transmission, Anemia, Sickle Cell, Hematopoietic Stem Cell Transplantation, Stem Cells, Transplants, Cell Transplantation, Conditioning, Psychological, Stem Cell Transplantation, Hematopoietic Stem Cells, Transplantation, Child