Cerebral hemodynamic changes after haploidentical hematopoietic stem cell transplant in adults with sickle cell disease

• DOI: 10.1182/bloodadvances.2023010717
• Publication Date: 2023-10-26T21:31:08Z
• Authors: Megan A. Aumann; Wesley Richerson; Alexander K. Song; L. Taylor Davis; Sumit Pruthi; Samantha Davis; Niral J. Patel; Chelsea Custer; Adetola A. Kassim; Michael R. DeBaun; Manus J. Donahue; Lori C. Jordan
• Keywords: Adult; Oxygen; Transplantation; Young Adult; Hematopoietic Stem Cell Transplantation; Hemodynamics; Humans; Anemia, Sickle Cell; Child; 3. Good health; Bone Marrow Transplantation

Abstract Preliminary evidence from a series of 4 adults with sickle cell disease (SCD) suggests that hematopoietic stem transplant (HSCT) improves cerebral hemodynamics. HSCT largely normalizes hemodynamics in children SCD. We tested the hypothesis SCD blood flow (CBF), oxygen extraction fraction (OEF), and metabolic rate (CMRO2) measured using magnetic resonance imaging, normalized to healthy values, comparing measurements ∼1 month before 12 24 months after (n = 11; age, 33.3 ± 8.9 years; 389 150 days HSCT) age-, race- sex-matched values without trait 28; 30.2 5.6 years). Before transplant, 7 patients had neurological indications for (eg, overt stroke) nonneurological reasons haploidentical bone marrow (haplo-BMT). All received haplo-BMT first-degree relatives (parent, sibling, or child donor) reduced-intensity preparation maintained engraftment. CBF was elevated (CBF, 69.11 24.7 mL/100 g/min) compared controls (P .004). Mean declined significantly (posttransplant CBF, 48.2 13.9 g/min; P .003). OEF not different at baseline did change (pretransplant, 43.1 6.7%; posttransplant, 39.6 7.0%; .34). After were 13.4 .78; OEF, > .99). CMRO2 3.18 0.87 mL O2/100 2.95 0.83; .56). Major complications included 1 infection-related death severe chronic graft-versus-host disease. Haplo-BMT reduces control maintains on average levels observed adult controls. The trial registered www.clinicaltrials.gov as #NCT01850108.