Clinical trial NCT04076683: Algorithm for Apherisis Monitoring and Prescription Assistance in Sickle Cell Patients (ALGODREP)
Official title: Validation d'Une Stratégie de Programme Transfusionnel Par Erythraphérèse basée Sur un Algorithme d'Aide à la Prescription Transfusionnelle Chez Les Patients Adultes Drépanocytaires
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Sickle Cell Disease
Keywords: Algorithm
Apherisis
Sickle cell patients
Lead sponsor: Etablissement Français du Sang
Sponsor class: OTHER
Collaborators: name: Assistance Publique - Hôpitaux de Paris
name: Paris 12 Val de Marne University
First posted: 2019-09-03
Enrollment: 65
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief summary: The main objective of this study is to prove the superiority of a procedure which calculates the volume of RBCs to transfuse and the time between apheresis based on this algorithm, compared to the current procedure. The primary endpoint would be the number of patients with individually achieved objectives in terms of % HbS before each apheresis (which reflects the effectiveness of the previous apheresis) over a period of 12 months. The secondary objectives would be to compare the volume differences of transfused RBCs in both groups over a period of 12 months, the occurrence of clinical events and the satisfaction of patients and physicians.

The investigators hope that this study would improve the efficiency and the performance of apheresis in sickle cell patients. The investigators also hope to facilitate the organization of procedures with the flexibility that would allow the use of this algorithm.

Detailed description: Sickle cell disease (SCD) is the most common genetic disease leading to abnormal hemoglobin (HbS). Chronic complications can be severe and affect multiple organs. Among them, cerebrovascular disease is one of the most serious leading to a high risk of stroke. These complications often require blood exchange transfusions (BET) in order to replace red blood cells (RBC) containing HbS (from patients) by GR containing HbA (blood donors), and thereby stop the harmful pathophysiological cascade. The indications of long-term apheresis are mostly, but not exclusively, represented by cerebral vasculopathy (85% in our center), and chronic organ damages. Long-term BET in cerebral vasculopathy may considerably reduce the risk of stroke while stopping them leads to a recurrence of this risk, hence there is a need to do them regularly (on average every 4 to 6 weeks) with an objective of HbS ≤ 30%. This objective may be less stringent in the case of other indications.

Two methods are used: a manual method which is feasible anywhere and the apheresis which is preferred because of its better efficacy in achieving the targets of HbS percentage. It also limits transfusion hemochromatosis.

The volume required for BET by apheresis as well as the optimal period between apheresis sessions are empirically determined.

In our practice, the investigators noticed that this method did not allow to steadily obtaining the %HbS objective and the interval between apheresis was variable, in part conditioned by the availability of machines. This implies a real risk of occurrence of recurrent stroke in patients with cerebral vascular disease and may cause a lack of flexibility in the timing of appointments.

Thereby the principal investigator and the biostatistician created an algorithm to compute the volume of blood to be transfused and the interval between apheresis which are necessary to maintain an individual objective of HbS percentage. This algorithm has been obtained by statistical analysis of apheresis performed at Henri Mondor Hospital over a period of 3 years.

Eligibility criteria: Inclusion Criteria:

* Age 18 years or older
* Have sickle cell disease, defined as those individuals with HbSS or HbSβ0Thal
* Included in a Blood Exchange Transfusion program (apherisis)
* Benefiting from social insurance
* Accepting to participate in the study and having signed the informed consent

Exclusion Criteria:

* Have sickle cell disease defined with S-β+thal
* Receiving EPO treatment
* Pregnant or breast-feeding women
* Lack of effective contraception in women in childbearing age
* Patient under guardianship

Primary outcomes:
measure: Number of patients with individually achieved objectives in terms of % HbS
timeFrame: For each apherisis over a 12 months period
Secondary outcomes:
measure: Volume of transfused RBCs
timeFrame: For each apherisis over a 12 months period
measure: Number of transfused RBCs
timeFrame: For each apherisis over a 12 months period
measure: Number of apherisis per participant
timeFrame: Over a 12 months period
measure: Hematocrit (percentage)
timeFrame: For each apherisis over a 12 months period
measure: Hemoglobin (g/dL)
timeFrame: For each apherisis over a 12 months period
measure: Number of reticulocyte (g/L),
timeFrame: For each apherisis over a 12 months period
measure: Percentage of reticulocyte
timeFrame: For each apherisis over a 12 months period
measure: Lactate dehydrogenase (UI/L)
timeFrame: For each apherisis over a 12 months period
measure: Creatinine (mg/L)
timeFrame: For each apherisis over a 12 months period
measure: Alanine aminotransferase (UI/L)
timeFrame: For each apherisis over a 12 months period
measure: Aspartate aminotransferase (UI/L)
timeFrame: For each apherisis over a 12 months period
measure: Bilirubin T (mg/dL)
timeFrame: For each apherisis over a 12 months period
measure: Percentage of alloimmunisation events evaluated with irregular red cell antibodies measure
timeFrame: For each apherisis over a 12 months period
measure: Quality of life questionnaire (SF-36)
timeFrame: At baseline and in 12 months
measure: Physician satisfaction survey for each participant
timeFrame: Month 12
Other outcomes:
Locations:
city: Saint-Priest-en-Jarez
country: France
facility: EFS Rhône-Alpes-Auvergne
state: Auvergne Rhône-Alpes
city: Besançon
country: France
facility: Centre de Santé EFS
state: Bourgogne Franche-Comté
city: Rennes
country: France
facility: Centre de Santé EFS
state: Bretagne
city: Tours
country: France
facility: Centre de Santé EFS
state: Centre-Val De Loire
city: Le Kremlin-Bicêtre
country: France
facility: CHU Kremlin Bicêtre
state: Ile De France
city: Créteil
country: France
facility: Hôpital Henri Mondor
state: Ile-de-France
city: Bordeaux
country: France
facility: Centre de Santé EFS
state: Nouvelle-Aquitaine
city: Le Lamentin
country: Martinique
facility: CHU de Martinique
Study officials:
affiliation: Henri Mondor University Hospital
name: Pablo BARTOLUCCI
role: PRINCIPAL_INVESTIGATOR
References:
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