Impact of chronic transfusion on incidence of pain and acute chest syndrome during the Stroke Prevention Trial (STOP) in sickle-cell anemia.
OBJECTIVE
The Stroke Prevention Trial (STOP) demonstrated that chronic transfusion is highly effective in reducing the risk of stroke in children with sickle-cell disease and an abnormal transcranial Doppler ultrasonography examination result. Our objective was to determine whether chronic transfusion therapy reduces the incidence of pain and acute chest syndrome.


METHODS
During STOP, 130 children with sickle-cell anemia or sickle beta(0)-thalassemia and abnormal transcranial Doppler ultrasonography examination result were randomly assigned to chronic transfusion (n = 63) or observation (n = 67). In addition to monitoring for stroke, nonneurologic sickle-cell complications were identified and recorded.


RESULTS
Mean age at STOP study entry was 8.3 +/- 3.3 years, and mean follow-up was 19.6 +/- 6.5 months. Hospitalization rates (based on intent-to-treat analysis) for acute chest syndrome were 4.8 and 15.3 per 100 patient-years (P =.0027) and for pain were 16.2 and 27.6 per 100 patient-years (P =.13) in the chronic transfusion and observed groups, respectively. If analyzed according to treatment actually received, the difference in pain rate becomes significant (9.7 vs 27.1 events per 100 patient-years, P =.014), and transfusion remains protective from acute chest syndrome (2.2 vs 15.7 events per 100 patient-years, P =.0001).


CONCLUSIONS
Compliance with aggressive chronic transfusion reduces the frequency of acute chest syndrome and pain episodes.
Miller
S T
ST
State University of New York-Downstate Medical Center/Kings County Hospital Center, Brooklyn, NY 11203, USA.
Wright
E
E
Abboud
M
M
Berman
B
B
Files
B
B
Scher
C D
CD
Styles
L
L
Adams
R J
RJ
D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000097:blood / Q000150:complications / Q000628:therapy*; D001803:Blood Transfusion; D002637:Chest Pain / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006451:Hemoglobin, Sickle / Q000032:analysis; D006760:Hospitalization; D006801:Humans; D015993:Life Tables; D008297:Male; D010146:Pain / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D010349:Patient Compliance; D012044:Regression Analysis; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D017585:Ultrasonography, Doppler, Transcranial
D006451:Hemoglobin, Sickle