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Chokri Ben Lamine: Pain After Allogeneic Stem Cell Transplantation in Sickle Cell Disease
Chokri Ben Lamine/LinkedIn
Oct 9, 2026, 14:07

Chokri Ben Lamine: Pain After Allogeneic Stem Cell Transplantation in Sickle Cell Disease

Chokri Ben Lamine, Hematologist at King Faisal Specialist Hospital and Research Center, shared a post on X:

” ‘VOC-like’ Pain After Allogeneic SCT for Sickle Cell Disease:

What Is the Differential?

1. First question: Is sickling recurring?

  • Consider graft rejection/failure or declining donor myeloid chimerism.
  • Check serial lineage-specific chimerism, Hb electrophoresis/HPLC and hemolysis markers.
  • Pain alone does not establish SCD recurrence.

2. Interpret HbS correctly

  • An HbAS donor can produce detectable HbS despite successful transplantation.
  • Interpret HbS against donor genotype, recent transfusions and chimerism trends.
  • Mixed chimerism does not automatically mean graft failure.

3. Persistent structural pain

  • Avascular necrosis, particularly of the hips and shoulders
  • Previous bone infarction or joint damage
  • Vertebral compression/insufficiency fractures
  • Focal pain or restricted movement warrants targeted imaging, including MRI when indicated.

4. Persistent chronic pain

  • Central sensitization and neuropathic pain can persist despite correction of sickling.
  • Consider opioid withdrawal during tapering and possible opioid-induced hyperalgesia.
  • Persistent pain deserves assessment and treatment, even with full donor engraftment.

5. Calcineurin inhibitor-induced pain syndrome

  • Consider tacrolimus/cyclosporine-associated pain in patients with severe, often symmetrical lower-limb symptoms.
  • Feet, ankles and knees are typical sites.
  • MRI may show marrow edema.

Therapeutic drug levels do not exclude this syndrome. Coordinate treatment changes with the bone marrow transplant (BMT) team.

6. Exclude urgent mimics

  • Osteomyelitis/septic arthritis: focal pain, with or without fever
  • DVT/PE: swelling, chest pain or hypoxia
  • Pneumonia; acute chest syndrome if sickling persists or recurs
  • Delayed hemolytic transfusion reaction/hyperhemolysis: recent transfusion, pain and falling hemoglobin

7. Other transplant complications

  • Chronic GVHD fasciitis/myositis: stiffness, weakness and reduced range of motion
  • Abdominal pain: consider GI GVHD, infection and other organ-specific pathology
  • Anemia, thrombocytopenia, hypertension or proteinuria: investigate transplant-associated thrombotic microangiopathy (TA-TMA)

8. Practical approach

  • Treat pain promptly while investigating.
  • Assess timing, pain pattern, vital signs, oxygen saturation, CBC/reticulocytes, hemolysis and renal profiles, HbS and chimerism trends.
  • Add cultures, transfusion testing and imaging according to clinical findings.
  • Successful SCT can stop sickling while pre-existing pain mechanisms persist.

Sources supporting the thread:

  • Recurrence and HbS interpretation: Donor chimerism and SCD recurrence
  • Persistent pain: Post-HCT pain study and ASH transplantation guideline
  • Calcineurin inhibitor pain: HSCT case report
  • Hemolytic and endothelial mimics: ASH transfusion guideline and TA-TMA consensus.”

Other posts featuring Chokri Ben Lamine on Hemostasis Today.

Chokri Ben Lamine Health Hematology Hemostasis Hemostasis News Hemostasis Today Medicine
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