Pain and opioid use after reversal of sickle cell disease following HLA‐matched sibling haematopoietic stem cell transplant

Red blood cell transfusion therapy for sickle cell patients with frequent painful events

“…This suggests that pain may be driven by factors outside of the red blood cell and occur at the level of the peripheral and/or central nervous system and one year of chronic red cell transfusion therapy likely does not reverse this process . This concept is corroborated by data post bone marrow transplantation where patients continue to require opioid medications after this curative therapy . A second possibility is that we used a surrogate marker of opioid prescription quantity filled rather than utilized.…”

“…16,17 This concept is corroborated by data post bone marrow transplantation where patients continue to require opioid medications after this curative therapy. 18 A second possibility is that we used a surrogate marker of opioid prescription quantity filled rather than utilized. This finding may be relevant for patients with frequent pain who continued to request opioid prescriptions at each clinic visit for transfusion for management of their pain at home.…”

Allogeneic Hematopoietic Stem Cell Transplantation for Adults with Sickle Cell Disease

“…In the reduced-intensity conditioning regimen developed by Ozdogu et al, the proportion of patients with ≥2 VOC/year improved from 90% pre-HSCT to no patients experiencing VOC after HSCT [50]. In the NIH cohort, pain-related admissions improved from a median of three/year pre-HSCT to zero/year at one year post-HSCT in those with stable long-term engraftment using the alemtuzumab/TBI regimen [73]. Improvements in the rates of VOC from a median of four/year pre-HSCT to a median of two/year at one year post-HSCT and to zero/year at two years post-HSCT have also been observed using the alemtuzumab/TBI regimen in the UIC cohort [74].…”

Chronic opioid use can be reduced or discontinued after haematopoietic stem cell transplantation for sickle cell disease

“…Our present results suggest that almost 80% of patients undergoing successful HSCT for SCD will no longer require opioids by 3 years after the transplant. Higher pain burden and more anxiety‐related symptoms before HSCT predict continuing opioid requirements after HSCT 6 . Our present results suggest that ≥50 mg OME/day before HSCT is a threshold for predicting persistent opioid use after HSCT.…”