Sickle Cell Treatment
Learning about the current treatment options for sickle cell will help you develop a comprehensive care plan with your healthcare team. Knowing how to manage symptoms and complications can help you or your loved ones better navigate sickle cell care.
Current available sickle cell treatments mainly focus on relieving pain and managing acute symptoms and complications. They aim to lessen the frequency and severity of pain crises, reduce blood transfusions and hospitalizations, or improve hemoglobin levels. Chronic pain is commonly treated with over-the-counter pain relievers. Pain medications may also be prescribed by a doctor to treat acute and chronic pain.
Some of the currently approved treatments available today include:
- An oral medication to treat people with sickle cell disease to help increase production of a working type of hemoglobin. Doing so may help make red blood cells less likely to turn into a sickle shape and stick together to block blood flow in blood vessels.
- An intravenous (IV) infusion for patients with sickle cell aged 16 years and older that is a type of medication known as a monoclonal antibody. This medication blocks the interaction of protein called P-selectin with blood cell lining and certain blood cells, which may help reduce severe pain crises, also known as “vaso-occlusive crises” or VOCs.
- Another oral medication was approved for patients aged 4 years and older. This is a type of medicine called a hemoglobin S polymerization inhibitor. This medication works by binding to hemoglobin and increasing its affinity to oxygen to prevent it from clumping and sickling, which can help improve hemoglobin level and reduce hemolysis.
- Another oral therapy to treat patients aged 5 years and older with sickle cell disease that plays various roles in cell metabolism, including antioxidant production and effects, which can help reduce episodes of sickle-cell related pain.
Please note, this list is not comprehensive of all currently approved treatments and therapies for sickle cell disease.
Blood transfusions can help relieve symptoms of sickle cell and potentially prevent stroke and other complications in high-risk patients. There are 2 types of transfusions used for people with sickle cell: A simple transfusion and a red blood cell exchange. In a simple transfusion, donated blood is given to a patient; in a red blood cell exchange, a patient’s red blood cells are removed and replaced with healthy red blood cells. Blood transfusions are a common procedure but risks can include an immune response to the donated blood, infection, and excess iron buildup in the body (iron overload).
HEMATOPOIETIC STEM CELL TRANSPLANT (HSCT)
An HSCT (also called a bone marrow transplant or stem cell transplant) is a type of treatment that replaces blood stem cells with cells from a donor. Bone marrow transplants are currently the only treatment that can lead to a cure; however, they are mostly limited to people who are under the age of 18 and have a matched-related donor available. Bone marrow transplants do not treat the underlying gene mutation that causes sickle cell.
Significant advancements have been made in the treatment of sickle cell, but it is not enough; serious medical and social burdens remain. There is still a need for treatments that can eliminate lifelong symptom management and its unwanted side effects.
Research in Sickle Cell Disease
Scientists continue to explore how to address unmet needs in the management and treatment of sickle cell. As of February 2021, there have been more than 350 clinical studies on sickle cell disease completed, with over 250 active or actively recruiting trials happening to date. From collecting information about diagnoses to improving current treatments and exploring new options, scientists aim to improve care for sickle cell every day.
Scientists are continuing to explore ways to expand available pharmacologic treatments to target and address symptoms and complications of sickle cell throughout the body. There are many different ways in which these treatments work and what they target in the body. Some methods being studied include treatments that aim to:
- stabilize sickled red blood cells to try to prevent them from breaking apart (hemolysis)
- reduce the frequency and effects of vaso-occlusion by impacting how different cells bind and stick to one another
- decrease the inflammation caused by damage from sickled red blood cells that contributes to organ damage
Some of the developing therapies being investigated today include:
- A type of selective pyruvate kinase-R (PKR) activator currently in development as an oral, once-daily medication for the treatment of sickle cell disease. It aims to help increase functioning hemoglobin, improve red blood cell health, and decrease hemolysis and vaso-occlusive crises (VOCs).
- A potential monoclonal antibody-based therapy being investigated with the goal of blocking P-selectin to help reduce vaso-occlusive crises (VOCs) in patients with sickle cell disease.
- An investigational, oral, small-molecule therapy designed to activate the enzyme pyruvate kinase-R (PKR) in people with sickle cell disease. It aims to help reduce the levels of 2,3-diphosphoglycerate (2,3-DPG) and increase adenosine triphosphate (ATP) production, and may help reduce hemolysis and red blood cell sickling.
Please note, this list is not comprehensive of all therapies currently in development for sickle cell disease.
Scientists are working to develop alternative approaches to help improve safety and reduce the transplant-related risks involved with HSCT, such as finding a less toxic regimen. They are also investigating how to expand the amount of donors available to a patient, as having a matched-related donor is a limitation for this treatment. As of February 2021, there were about 60 active or recruiting trials studying HSCT in patients with sickle cell disease.
Gene therapy is a treatment approach that aims to treat diseases at the genetic, or DNA, level with the goal of changing the course of a disease. Gene therapy is currently being studied in a number of diseases, including sickle cell disease. Gene therapy for sickle cell disease is currently not FDA-approved. Safety and efficacy have not been established. Learn more about gene therapy and how it works.
Screening and data collection
The Centers for Disease Control and Prevention (CDC) has partnered with other groups to help enhance newborn screening programs to include sickle cell screening throughout the United States. This initiative aims to improve screening results to help patients and their families get connected to healthcare resources to better manage their conditions and improve long-term health. The CDC has also created a data collection program to study long-term trends in diagnosis, treatment, and healthcare access for people with sickle cell.
Healthcare worker training
In 2014, the CDC began working with partners to better understand health issues that can occur for patients receiving blood transfusions. In addition to improving overall quality and length of life, the program aimed to develop training on transfusion guidelines for healthcare providers. In 2020, the Department of Health and Human Services launched the Sickle Cell Disease Training and Mentoring Program (STAMP) to train healthcare workers in sickle cell care and promote physicians and specialists working together to support their patients.
The Sickle Cell Disease Association of America offers a Sickle Cell Disease Community Health Worker Training program. This online course offers a concentration in sickle cell disease in addition to covering the core competencies of community health workers.