Five years ago, we had only one treatment for sickle cell disease, a disease that should not be taken lightly.

This disease can be a pain-generating disease that actually affects all organs of the body. This can start at the heart, blood vessels, brain, joints, bones and also the lungs.

Sickle cell is due to a mutation of a tiny gene that leads to an unstable hemoglobin. The sickles in the hemoglobin, when stressed, deprive tissue from oxygen that can lead to what we call crisis.

Crisis starts with pain, but it can also lead to stroke, heart attack and limb loss. Sickle cell crisis is when the abnormal cell gets stuck in the small blood vessels.

Sickle cell disease affects approximately 100,000 people in the United States. For years, the only therapeutic option was Hydroxyurea. This drug has been in existence since 1984. We know that this drug works, since it has proved to be effective in increasing hemoglobin, reducing pain and acute chest syndrome.

This drug has also decreased the number of blood transfusions in patients who suffer from sickle cell disease. Unfortunately, Hydroxyurea is chemotherapy and requires close monitoring. This therapy works over time with each patient; therefore, not all patients will respond equally. Since Hydroxyurea was introduced, there has been a need for new treatments. For the past several years, more therapies have started to emerge.

The first notable drug that has been FDA approved in 2017, since Hydroxyurea, is L-glutamine (Endari). This drug works on the inflammatory part of the disease. It has also proved to decrease the number of pain crisis and lessen acute chest syndrome.

The second drug is Voxelotor. This drug is a once-daily pill that stabilizes the oxygenated hemoglobin. Trials have proved to make patients less anemic, but events are not necessarily less painful. More long-term studies are looking at this issue. This drug is available, and FDA approved, through an accelerated program.

The third drug is Crizanlizumab. This drug helps with the stickiness of the red blood cells against the sticky vessel wall. This is one of the detrimental aspects of this disease. A randomized study called SUSTAIN proved that this intravenous drug decreases the number of painful crisis. This drug was FDA approved through a breakthrough therapy program.

Lastly, there is gene therapy. This type of treatment consists of an auto stem cell transplant of a viral infected, anti-sticking hemoglobin. This therapy still requires chemotherapy to wipe out the bone marrow so that space can be made for the transplant. The results of this treatment have been very successful.

Many promising therapies are seeing the light and are changing the care of this complex disease so that patients with sickle cell disease can lead a semi-normal lifestyle.

Dr. Ziad Skaff is board certified in hematology and oncology. He serves as chief of staff of MUSC Health-Florence Medical Center and Medical Director of Oncology Services. Dr. Skaff is associated with MUSC Health Hematology & Oncology, located at 805 Pamplico Highway, Medical Pavilion A, Suite 315. To schedule an appointment, call 843-674-6460.

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Sickle cell treatment then and now - SCNow

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