Bone Marrow Transplants May Lower Risk of Stroke in Patients With Sickle Cell Disease

Bone marrow transplantation may help to prevent or improve blood vessel disease in the brains of patients with sickle cell disease, according to research that will be presented at the American Stroke Association’s International Stroke Conference 2023. The procedure may also help to lower the risk of stroke in children and adults with sickle cell disease, according to the study.

Sickle cell can cause blood vessel complications in the brain such as vasculopathy, “where some vessels may become enlarged like an aneurysm, or some vessels may narrow and block,” said lead study author John K. Lynch, DO, MPH, associate research physician at the National Institute of Neurological Disorders and Stroke (NINDS), a division of the National Institutes of Health, in a press release. Patients may also develop silent brain injuries because of vasculopathy, Lynch explained.

Sickle cell disease arises when abnormally shaped red blood cells create blockages in blood vessels, Lynch explained in the press release. The blockages may be caused by the abnormal narrowing or bulging of the brain’s blood vessels, which can increase a patient’s risk of stroke. Stroke can cause high mortality and lead to disabilities in children and adults with sickle cell.

The aim of the study was to determine whether receiving stem cell transplants could positively change blood vessel irregularities in the brain in patients with sickle cell disease over a long duration, Lynch said.

The study cohort included adults with sickle cell disease who received a bone marrow transplant between 2004 and 2019. Patients received pre- and post-operational magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), which was used to show whether there were signs of narrowing blood vessels in 8 brain arteries. The patients were also scored for the presence of aneurysm and received follow-up at 3 years.

Pre-transplant, 28% had blood vessel issues in the brain, with a larger percentage having narrowed blood vessels compared to bulging ones at 17% and 13%, respectively. Following transplantation, none of the patients developed any of these vessel abnormalities.

“We suspect that the reduction in the number of sickle cells and the improvement of the cells’ oxygen-carrying capacity led to a reduction in the number of strokes after bone marrow transplantation,” Lynch said in the press release.

Additionally, 62% of patients with initial narrowing vessel abnormalities had improved symptoms after the bone marrow transplant, according to brain imaging.

There are limitations to the study, such as that it excluded a comparison group of patients who did not get the bone marrow transplant, and patients were followed for different durations of time, not receiving a uniform follow-up.

“Our hope is that bone-marrow transplantation may be considered more often for people with sickle cell disease and that other less invasive and potentially life-saving treatments may be developed for people with sickle cell disease,” Lynch said in the press release.

Reference

American Heart Association. Bone marrow transplant may halt brain blood vessel disease in adults with sickle cell disease. News Release. February 2, 2023. Accessed February 2, 2023. https://www.eurekalert.org/news-releases/977892