Sickle Cell Disease
Conditions
Keywords
Hematopoietic stem cell transplantation
Brief summary
The long term burden of morbidity and mortality in the natural history of sickle cell disease has not been compared up to date to the risks and mortality of a curative option like bone marrow transplantation in severe sickle-cell disease patients. Given this lack of data, primary-care Sickle Cell Disease (SCD) physicians and transplant physicians are prevented from a factual debate over the benefit/risk ratio for each patient and refining indications of transplant in patients. Therefore, the present study seeks to describe and compare the very long-term outcomes after either Human Leukocyte Antigen (HLA) -matched sibling transplantation (study arm) and non-transplant care for severe sickle cell disease SCA patients in order to yield robust comparative data regarding both arms. The main objective is to assess the benefit of Hematopoietic stem cell transplantation (HSCT) regarding quality of life compared to standard care after 10 years, in patients with severe Sickle Cell Disease (SCD).
Interventions
OTHERSpermogram
Spermogram will be proposed to men
Anxiety and depression will be evaluated 10 years after HSCT
OTHERSF36 Quality of life questionnaire
Quality of life will be evaluated 10 years after HSCT
OTHERPsychologist interview
During a follow-up visit
OTHEROptional sera banking
One in the study
OTHEROptional DNA banking
Once in the study
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
15 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
Study population (exposed-patients), all criteria should be fulfilled: 1. Patients alive with Sickle Cell Anemia (SCA, meaning SS and Sbeta0 sickle cell anemia genotype) 2. Patients transplanted from allogeneic HLA-compatible sibling donor or from sibling cord blood unit from the 1st of January 2000 and the 31st of December 2012, whatever the age at transplant 3. Patients having received conditioning regimen containing busulfan 1mg/kg/dose (or equivalent adjusted body-weight dosage according to recommendation) x 16 doses + cyclophosphamide 200mg/kg total dose + anti-thymoglobuline 4. For patient under 18 years at time of enrolment, signed informed consent from both parental representatives 5. For patient aged 18 years old : signed informed consent 6. Having an affiliation to a social security regime Control-population (Non-exposed patients) : For each allografted patient, one non-exposed patient will be matched, based on the following criteria: * Gender * Age at the date of transplantation of the exposed patient (+/- 1 year) * Foetal hemoglobin (HbF) level (+/- 3%) before treatment intensification (defined as the initiation of either hydroxyurea or a transfusion program) * Hb level (+/- 0,9 g/dl) before treatment intensification 1. For patient under 18 years at time of enrolment, signed informed consent from both parental representatives 2. For patient above 18 years of age: signed informed consent 3. Having an affiliation of to a social security regime
Exclusion criteria
Study population: * Transplantation from donor other than sibling or related cord-blood * Conditioning regimen other than busulfan 16mg/kg total dose + cyclophosphamide 200mg/kg total dose + anti-thymoglobuline For both population: * Absence of signed informed consent * Having any debilitating medical or psychiatric illness, which preclude understanding of the inform consent as well as optimal treatment and follow-up
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Evaluation of quality of life assessed by SF36 | 10 years after HSCT | It will be assessed by the Short-form 36 (SF36) scale. The Short Form (36) Health Survey is a 36-item measure if health status. The score obtained varies between 0 and 100. The higher the score the less disability. Ware JE, Sherbourne CD. The Medical Outcomes Study 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care 1992;30:473-83. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Evaluation of gonadal function | 10 years after HSCT | Spermogram in men (proposed not requested), Luteinising Hormone (LH), Follicle-Stimulating Hormone (FSH), estrogen, Anti-Müllerian Hormone (AMH) in women, testosterone in men, Amenorrhea in women. |
| Evaluation of quality of life | 10 years after HSCT | Questionnaire including data about employment, education level, social financial support. |
| Proportion of patients with anxiety and depression | 10 years after HSCT | Anxiety and depression levels will be assessed using the Hamilton Anxiety Depression scale : The HAD scale is a self-assessment scale for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. HADS is a self-administered scale of 14 items which assessed levels of depression and anxiety, divided into 2 subscales of 7 items (Anxiety or HADS-A, Depression or HADS-D). Each item is scored on a scale of 0 to 3. A score is generated for each of the two sub-scales (sum of the 7 items, ranging from 0 to 21). Limit scores, for each of the scores, distinguish: non-cases or asymptomatic ones (score ≤ 7); probable or borderline cases (score 8-10); clearly or clinically symptomatic cases (score ≥ 11) |
Contacts
Primary ContactJean-Hugues Dalle, Pr
Backup ContactJérôme Lambert, Pr
Outcome results
None listed