What Are the Risk Factors for Pain Crisis in Patients With SCD After HSCT?

Age, weight, graft failure (GF), history of pain crisis, conditioning intensity, and donor type are predictors of pain crisis after hematopoietic stem cell transplantation (HSCT) in patients with sickle cell disease (SCD), according to a recent study.

The retrospective, registry-based study was led by Lakshmanan Krishnamurti, MD, of the Yale School of Medicine, and published in Blood Advances. Dr. Krishnamurti and colleagues examined records of 763 patients who underwent HSCT for SCD and were followed up for a median of 36.7 months.

Of these patients, 66 (8.65%) developed pain crisis following HSCT. Forty-one had GF (62.12%) and 25 (37.88%) had pain crisis despite stable engraftment.

Patients with GF had a higher risk of pain crisis (odds ratio [OR], 7.15; 95% CI, 4.20-12.18; P<.0001). Patients with GF who did not experience pain crisis after HSCT were younger than those who did (median of 11 years vs 21 years, respectively; P<.0001). Similarly, patients who did not experience pain crisis after stable engraftment were younger than those who did (median of 11 years vs 26 years, respectively; P<.001).

Compared with human leukocyte antigen (HLA) identical sibling donors, patients who received HSCT from HLA mismatched relative donors (OR, 4.80; 95% CI, 2.48-9.31; P<.0001), unrelated matched donors (OR, 2.71; 95% CI, 1.23-5.97; P=.0132), and mismatched unrelated donors (OR, 3.19; 95% CI, 1.44-7.05; P=.0041) had a higher risk of pain crisis.

Pain crisis occurred less frequently in patients with a Karnofsky performance score ≥90 (OR, 0.31; 95% CI, 0.18-0.55; P<.0001).

Due to the nature of registry-based studies, the authors noted the difficulty of data collection once patients are no longer followed up by their transplant physician. However, “these data can inform studies aimed at identifying, preventing, and mitigating the risk of occurrence of pain crisis after HSCT for SCD,” Dr. Krishnamurti and colleagues concluded.

Reference

Krishnamurti L, Liang J, He Z, et al. Incidence and risk factors of pain crisis after hematopoietic cell transplantation for sickle cell disease. Blood Adv. 2024. doi.org/10.1182/bloodadvances.2023010749