Observational Study to Deeply Phenotype Major Organs in Sickle Cell Disease After Curative Therapies
Background: People with sickle cell disease (SCD) have problems with their heart, brain, kidneys, liver, and lungs as they age. These problems may improve after transplant. Researchers want to learn how and why this happens.
Objective: To study the benefits of treatments that are intended to cure SCD.
Eligibility: People aged 18 and older with SCD who are either receiving curative therapy in the next 3 months or don t have any plans to receive a curative therapy in the next 2 years.
Design: At their first visit, participants will be screened with their medical history and a physical exam. Participants will then have a baseline visit. This will take about a week to complete and will include: Blood and heart tests MRI of the brain, heart, and lungs. Participants will lie on a bed that will move into the MRI scanner. Special padding may be placed around their head to keep it still. Interactive games. Participants will complete computer games that test memory, attention, problem solving, language, spatial orientation, processing speed, and emotion. Questionnaire rating quality of life Iothalamate test. An IV catheter will be placed into a vein. A contrast agent will be injected through the IV. Blood will then be collected at different time points. Lung function tests and a 6-minute walk test Vibration controlled transient elastography. A probe placed on the abdomen will measure liver scarring. DOS test. A light attached to the finger or toe will measure blood oxygen. Participants will have an end-of-study visit about 2 years after their baseline visit. This will include repeats of the baseline visit tests.
∙ In order to be eligible to participate in this study, an individual must meet all of the following criteria:
• Stated willingness to comply with all study procedures and availability for the duration of the study
• Male or female, aged \>=18 years
• Current or previous diagnosis of any type of SCD (including HbSS, HbSC, HbSbeta0-thal, HbSbeta+-thal)
• Ability to travel to the NIH Clinical Center
• Ability of subject to understand and the willingness to sign a written informed consent document.
• Ability to undergo required studies except as specified in the Exclusion Criteria.
• Curative Therapies Group
⁃ -Plan to receive conditioning for curative therapy at the NIH Clinical Center, Vanderbilt University Medical Center, or Johns Hopkins Hospital
• Non-Curative Therapy Group
• \-- No plan to undergo curative therapy within 2 years
• At least one of the following eligibility criteria:
‣ History of stroke or abnormal transcranial doppler examination (\>= 200 m/s)
⁃ History of SCD-related renal insufficiency defined as a creatinine level \>=1.3 mg/dL and kidney biopsy consistent with sickle cell nephropathy OR nephrotic syndrome OR creatinine clearance \< 50mL/min
⁃ Tricuspid regurgitant velocity \>= 2.5 m/s
⁃ Recurrent tricorporal priapism defined as at least 2 episodes of an erection lasting \> 4 hours involving the corpora cavernosa and corpus spongiosa
⁃ SCD-associated liver disease defined as EITHER ferritin \> 1000 mcg/L OR direct bilirubin \> 0.4 mg/dL
⁃ \> 1 hospitalization per year for vaso-occlusive crises while on a therapeutic dose of hydroxyurea
⁃ Any acute chest syndrome while on a therapeutic dose of hydroxyurea
⁃ Osteonecrosis of 2 or more joints
⁃ Red cell alloimmunization