very few cases have been reported so far. Lucarelli and Gaziev14
reviewed the limited international experience in thalassemia and
sickle cell disease that showed overall poor results and a very
reduced rate of sustained engraftment (only 1 in 11 transplants).
More recently, a successful trial has been published in a small
cohort of adult patients with sickle cell disease (n 11) conditioned
with 300 cGy of total body irradiation and alemtuzumab.30 However,
this study is not immediately applicable to thalassemia. There
are, in fact, several relevant differences between thalassemia major
and sickle cell disease, which impact HSCT-based approaches.
Thalassemia major is characterized by ineffective erythropoiesis
and variable erythroid expansion. Ineffective erythropoiesis and
chronic transfusion lead to iron overload. Thus, for thalassemia, a
conditioning regimen capable of eradicating an expanded bone
marrow and providing adequate immunosuppression to sustain
engraftment with acceptable toxicity on iron-damaged tissues is
required. These challenges are not present in sickle cell disease. The
approach to patients with sickle cell disease is different than in
thalassemias, due to the fact that transfusion therapy is not standard
practice for all patients, the transfusion burden is less relevant, and
the expansion of the erythroid marrow is not as massive.
very few cases have been reported so far. Lucarelli and Gaziev14reviewed the limited international experience in thalassemia andsickle cell disease that showed overall poor results and a veryreduced rate of sustained engraftment (only 1 in 11 transplants).More recently, a successful trial has been published in a smallcohort of adult patients with sickle cell disease (n 11) conditionedwith 300 cGy of total body irradiation and alemtuzumab.30 However,this study is not immediately applicable to thalassemia. Thereare, in fact, several relevant differences between thalassemia majorand sickle cell disease, which impact HSCT-based approaches.Thalassemia major is characterized by ineffective erythropoiesisand variable erythroid expansion. Ineffective erythropoiesis andchronic transfusion lead to iron overload. Thus, for thalassemia, aconditioning regimen capable of eradicating an expanded bonemarrow and providing adequate immunosuppression to sustainengraftment with acceptable toxicity on iron-damaged tissues isrequired. These challenges are not present in sickle cell disease. Theapproach to patients with sickle cell disease is different than inthalassemias, due to the fact that transfusion therapy is not standardpractice for all patients, the transfusion burden is less relevant, andthe expansion of the erythroid marrow is not as massive.
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