title: Bone marrow transplant options and preferences in a sickle cell anemia cohort on chronic transfusions.
abstract: BACKGROUND
  Bone marrow transplantation (BMT) using human leukocyte antigen (HLA)-matched sibling donors can be curative for children with sickle cell anemia (SCA). However, minimal data exist regarding availability of HLA-identical matched siblings for transplant-eligible children, and family interest in pursuing transplantation.
  
  
  METHODS
  We retrospectively analyzed a pediatric SCA cohort receiving chronic transfusions between July 2004 and January 2011. Data were analyzed regarding the number of full siblings and half-siblings, availability, and family interest in HLA testing the full siblings, and interest in proceeding with HLAmatched transplantation.
  
  
  RESULTS
  Among 113 patients, 46 (41%) had at least 1 full sibling and 40 (35%) had an unaffected full sibling who could serve as a BMT donor. The families of 23 of these patients (58%) agreed to HLA-type sibling, 8 of whom (35%) were matched. Transfusion indications for families agreeing to HLA typing included stroke (46%) abnormal TCD (29%), acute chest syndrome (21%), and other CNS reasons (4%). Common reasons to decline HLA typing or transplantation included fear of the process, toxicities of the procedure, and comfort with current quality of life on transfusions. Only 8 of 113 (7%) were eligible for matched BMT, and only 3 (3%) underwent HLA-matched transplantation. Two unmatched children received haploidentical transplantation.
  
  
  CONCLUSIONS
  Most families of children with SCA on chronic transfusions choose to proceed with HLA typing. However, when a matched sibling was identified, most families declined to proceed with matched-sibling transplantation. Discussing BMT as a treatment option, offering HLA typing and identifying barriers may improve acceptance of this treatment modality.
authors.affiliation: Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Eileen N
authors.initials: EN
authors.lastname: Hansbury
authors.forename: William H
authors.initials: WH
authors.lastname: Schultz
authors.forename: Russell E
authors.initials: RE
authors.lastname: Ware
authors.forename: Banu
authors.initials: B
authors.lastname: Aygun
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000628:therapy*; D001803:Blood Transfusion; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014184:Transplantation, Homologous