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Mahar UR, Ahsan B, Ahmad U, Bokhari SW. Developing an Allogeneic Hematopoietic Progenitor Cell Transplant Service in a Resource-Limited Country: Challenges and Outcomes. Cureus 2023; 15:e44818. [PMID: 37809142 PMCID: PMC10559081 DOI: 10.7759/cureus.44818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Allogeneic stem cell transplant has curative potential for many hematological disorders. Building an allogeneic hematopoietic progenitor cell transplant (HPCT) unit requires huge investment, infrastructure, equipment, medical supplies, and training of health care professionals. The key objective of this study is to share our experience of developing an allogeneic HPCT service at our tertiary care cancer hospital in a low-middle-income country. In addition, this study presents the outcomes of the first 30 allogeneic HPCTs done at our center. Methods This retrospective observational study included adult patients 18 years old or older with hematological malignancies who underwent allogeneic HPCT between July 2019 and April 2023 at Shaukat Khanum Memorial Cancer Hospital and Research Centre. Result Of the 30 patients, 24 underwent matched sibling donor (MSD) transplants in which a myeloablative-conditioning regimen (MAC) was used in 19, and a reduced conditioning regimen (RIC) was used in one. Of the six haploidentical-related donor transplants, four received MAC, and two received RIC. The median recipient age at HPCT was 23 and 21 years for MSD and Haplo-related donor transplants, respectively. The median follow-up duration was 12 months (Range: 10 days - 33 months). The overall survival rate at one year was 71.3% among all allogeneic stem cell transplant patients, whereas the disease-free survival rate at one year was 63.7%. In the acute lymphoblastic leukemia group, the disease-free survival rate at one year post allograft was 51.5%, while in the acute myeloid leukemia group, it was 78.7%. Conclusion This study demonstrates the successful development of an allogeneic bone marrow transplant unit at our hospital despite significant financial constraints. This has allowed us to provide a potentially curative and life-saving treatment to a substantial number of cancer patients. The bone marrow transplant outcomes of this study are comparable to those reported by international bone marrow transplant registries.
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Affiliation(s)
- Uzma R Mahar
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Bushra Ahsan
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Usman Ahmad
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Syed W Bokhari
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Sen T, Thummer RP. The Impact of Human Microbiotas in Hematopoietic Stem Cell and Organ Transplantation. Front Immunol 2022; 13:932228. [PMID: 35874759 PMCID: PMC9300833 DOI: 10.3389/fimmu.2022.932228] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
The human microbiota heavily influences most vital aspects of human physiology including organ transplantation outcomes and transplant rejection risk. A variety of organ transplantation scenarios such as lung and heart transplantation as well as hematopoietic stem cell transplantation is heavily influenced by the human microbiotas. The human microbiota refers to a rich, diverse, and complex ecosystem of bacteria, fungi, archaea, helminths, protozoans, parasites, and viruses. Research accumulating over the past decade has established the existence of complex cross-species, cross-kingdom interactions between the residents of the various human microbiotas and the human body. Since the gut microbiota is the densest, most popular, and most studied human microbiota, the impact of other human microbiotas such as the oral, lung, urinary, and genital microbiotas is often overshadowed. However, these microbiotas also provide critical and unique insights pertaining to transplantation success, rejection risk, and overall host health, across multiple different transplantation scenarios. Organ transplantation as well as the pre-, peri-, and post-transplant pharmacological regimens patients undergo is known to adversely impact the microbiotas, thereby increasing the risk of adverse patient outcomes. Over the past decade, holistic approaches to post-transplant patient care such as the administration of clinical and dietary interventions aiming at restoring deranged microbiota community structures have been gaining momentum. Examples of these include prebiotic and probiotic administration, fecal microbial transplantation, and bacteriophage-mediated multidrug-resistant bacterial decolonization. This review will discuss these perspectives and explore the role of different human microbiotas in the context of various transplantation scenarios.
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Niederwieser D, Baldomero H, Bazuaye N, Bupp C, Chaudhri N, Corbacioglu S, Elhaddad A, Frutos C, Galeano S, Hamad N, Hamidieh AA, Hashmi S, Ho A, Horowitz MM, Iida M, Jaimovich G, Karduss A, Kodera Y, Kröger N, Péffault de Latour R, Lee JW, Martínez-Rolón J, Pasquini MC, Passweg J, Paulson K, Seber A, Snowden JA, Srivastava A, Szer J, Weisdorf D, Worel N, Koh MBC, Aljurf M, Greinix H, Atsuta Y, Saber W. One and a half million hematopoietic stem cell transplants: continuous and differential improvement in worldwide access with the use of non-identical family donors. Haematologica 2022; 107:1045-1053. [PMID: 34382386 PMCID: PMC9052915 DOI: 10.3324/haematol.2021.279189] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/21/2021] [Indexed: 11/22/2022] Open
Abstract
The Worldwide Network of Blood and Marrow Transplantation (WBMT) pursues the mission of promoting hematopoietic cell transplantation (HCT) for instance by evaluating activities through member societies, national registries and individual centers. In 2016, 82,718 first HCT were reported by 1,662 HCT teams in 86 of the 195 World Health Organization member states representing a global increase of 6.2% in autologous HCT and 7.0% in allogeneic HCT and bringing the total to 1,298,897 procedures. Assuming a frequency of 84,000/year, 1.5 million HCT were performed by 2019 since 1957. Slightly more autologous (53.5%) than allogeneic and more related (53.6%) than unrelated HCT were reported. A remarkable increase was noted in haploidentical related HCT for leukemias and lymphoproliferative diseases, but even more in non-malignant diseases. Transplant rates (TR; HCT/10 million population) varied according to region reaching 560.8 in North America, 438.5 in Europe, 76.7 in Latin America, 53.6 in South East Asia/Western Pacific (SEA/WPR) and 27.8 in African/East Mediterranean (AFR/EMR). Interestingly, haploidentical TR amounted to 32% in SEA/WPR and 26% in Latin America, but only 14% in Europe and EMR and 4.9% in North America of all allogeneic HCT. HCT team density (teams/10 million population) was highest in Europe (7.7) followed by North America (6.0), SEA/WPR (1.9), Latin America (1.6) and AFR/EMR (0.4). HCT are increasing steadily worldwide with narrowing gaps between regions and greater increase in allogeneic compared to autologous activity. While related HCT is rising, largely due to increase in haploidentical HCT, unrelated HCT is plateauing and cord blood HCT is in decline.
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Affiliation(s)
- Dietger Niederwieser
- University, Leipzig, Germany; Aichi Medical University School of Medicine, Nagakute, Japan; Lithuanian University of Health Sciences, Kaunas.
| | - Helen Baldomero
- The Worldwide Network of Blood and Marrow Transplantation (WBMT) Transplant Activity Survey Office, University Hospital, Basel.
| | - Nosa Bazuaye
- African Blood and Marrow Transplantation Group - AfBMT; University of Benin Teaching Hospital, PMB 1111.
| | - Caitrin Bupp
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis.
| | - Naeem Chaudhri
- EMBMT and Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Selim Corbacioglu
- European Society for Blood and Marrow Transplantation (EBMT), Passeig Taulat 116, 08005, Barcelona, Spain; Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg.
| | - Alaa Elhaddad
- African Blood and Marrow Transplantation Group - AfBMT; Department of Pediatric Oncology and Stem Cell Transplantation Unit, Cairo University Cairo.
| | - Cristóbal Frutos
- Latin American Blood and Marrow Transplantation Group - LABMT; Cristóbal Frutos, Instituto de Previsión Social, Asunción.
| | - Sebastian Galeano
- Latin American Blood and Marrow Transplantation Group - LABMT; Sebastian Galeano, Hospital Británico, Montevideo.
| | - Nada Hamad
- Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), St. Vincent´s Hospital Sydney, Australia; St. Vincent's Health Network, Kinghorn Cancer Centre.
| | - Amir Ali Hamidieh
- The Eastern Mediterranean Blood and Marrow Transplant Group (EMBMT), King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Pediatric Cell Therapy Research Center Tehran University of Medical Sciences Tehran.
| | - Shahrukh Hashmi
- Sheikh Shakhbout Medical City, Abu Dhabi, UAE; MAYO Clinic, Rochester, MN.
| | - Aloysius Ho
- The Asia Pacific Blood and Marrow Transplant Group (APBMT), Aichi Medical University School of Medicine, Nagakute, Japan; Singapore General Hospital Singapore.
| | | | - Minako Iida
- The Asia Pacific Blood and Marrow Transplant Group (APBMT), Aichi Medical University School of Medicine, Nagakute, Japan; Aichi Medical University School of Medicine, Dept. of Promotion for Blood and Marrow Plantation, Nagakute. ;
| | - Gregorio Jaimovich
- Latin American Blood and Marrow Transplantation Group - LABMT; Fundación Favaloro, Sanatorio Anchorena, ITAC, Buenos Aires.
| | - Amado Karduss
- Latin American Blood and Marrow Transplantation Group - LABMT; Instituto de Cancerología-Clínica Las Américas, Medellín.
| | - Yoshihisa Kodera
- The Asia Pacific Blood and Marrow Transplant Group (APBMT), Aichi Medical University School of Medicine, Nagakute, Japan; Aichi Medical University School of Medicine, Dept. of Promotion for Blood and Marrow Plantation, Nagakute. ;
| | - Nicolaus Kröger
- European Society for Blood and Marrow Transplantation (EBMT), Passeig Taulat 116, 08005, Barcelona, Spain; Department of Stem Cell Transplantation, University Medical Center Hamburg, Hamburg.
| | - Regis Péffault de Latour
- European Society for Blood and Marrow Transplantation (EBMT), Passeig Taulat 116, 08005, Barcelona, Spain; Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75010 PARIS.
| | - Jong Wook Lee
- The Asia Pacific Blood and Marrow Transplant Group (APBMT), Aichi Medical University School of Medicine, Nagakute, Japan; Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Juliana Martínez-Rolón
- Latin American Blood and Marrow Transplantation Group - LABMT; FUNDALEU, Buenos Aires, Argentina.
| | | | - Jakob Passweg
- European Society for Blood and Marrow Transplantation (EBMT), Passeig Taulat 116, 08005, Barcelona, Spain; Chefarzt Klinik für Hämatologie, Universitätsspital Basel, Petersgraben 4, 4031 Basel Switzerland.
| | - Kristjan Paulson
- CancerCare Manitoba and the University of Manitoba; Cell Therapy Transplant Canada (CTTC), Winnipeg, Manitoba.
| | - Adriana Seber
- Latin American Blood and Marrow Transplantation Group - LABMT; Pediatric Department, Hospital Samaritano, Sao Paulo.
| | - John A Snowden
- European Society for Blood and Marrow Transplantation (EBMT), Passeig Taulat 116, 08005, Barcelona, Spain; Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield.
| | - Alok Srivastava
- The Asia Pacific Blood and Marrow Transplant Group (APBMT), Aichi Medical University School of Medicine, Nagakute, Japan; Christian Medical College, Vellore.
| | - Jeff Szer
- ABMTRR, St. Vincent Hospital, Sydney; Peter MacCallum Cancer and Royal Melbourne Hospital, Parkville.
| | - Daniel Weisdorf
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN; University of Minnesota, MMC 480, Minneapolis, MN 55455. ;
| | - Nina Worel
- Medical University of Vienna, Dept. of Blood Group Serology and Transfusion Medicine, Vienna.
| | - Mickey B C Koh
- Infection and Immunity Clinical Academic Group, St George's Hospital and Medical School, London; Academic Cell Therapy Facility and Programme Health Sciences Authority Singapore.
| | - Mahmoud Aljurf
- EMBMT and King Faisal Specialist Hospital and Research Center, Riyadh.
| | | | - Yoshiko Atsuta
- The Asia Pacific Blood and Marrow Transplant Group (APBMT), Aichi Medical University School of Medicine, Nagakute, Japan; Japanese Data Center for Hematopoietic Cell Transplantation (JDCHCT), Nagoya.
| | - Wael Saber
- CIBMTR, Medical College of Wisconsin, Milwaukee. ; ;
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Poudyal BS, Tuladhar S, Neupane S, Sapkota S, Pandit S, Shrestha PR, Poudel B, Bajaracharya M, Sweiss K, Patel P, Mahmud N, Rondelli D. Hematopoietic Stem Cell Transplantation in Nepal: international partnership, implementation steps and clinical outcomes. Transplant Cell Ther 2022; 28:268-275. [PMID: 35182794 DOI: 10.1016/j.jtct.2022.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 10/19/2022]
Abstract
Blood & Marrow Transplantation (BMT) is rarely available in many low-middle-income countries (LMIC). In 2012, Civil Service Hospital, a government hospital in Kathmandu (Nepal) partnered with the University of Illinois at Chicago (USA) to consult on the establishment of BMT in their hospital, train staff and promote educational activities. The implementation of BMT occurred in 3 phases over 4 years and included: regular on-site visits, training of personnel in Chicago, continuous remote communication, co-organization of educational events in Kathmandu. The Nepalese government funded the construction of a state-of-the art BMT unit and stem cell lab inside Civil Hospital. Autologous hematopoietic stem cell transplant (HSCT) was started in 2016 and allogeneic HSCT from matched related (MRD) or haploidentical (Haplo) donors in 2017. Transplant cost was $5,200 for autologous, $10,000 for MRD and $13,300 for Haplo HSCT. The major socio-economic determinants reported by Nepalese BMT providers were: cost of transplant, loss revenue of the patient or caregiver and cost of transportation. All patients (n=66) received peripheral blood stem cell grafts and all allogeneic HSCT received post-transplant cyclophosphamide (PTCy) as graft versus host disease (GVHD) prophylaxis. In autologous HSCT (n=30), with a median follow-up of 1029 days (range:130-1653) 87% were alive, and transplant-related mortality (TRM) was 10%. In allogeneic HSCT (n=36), all patients engrafted and with a median follow-up of 204 days (range: 12-1131) 75% of them were alive (MRD: 71%, Haplo: 83%), with a TRM of 19%. Only 3 of 36 patients developed acute GVHD ≥ grade 2. Median overall survival (OS) in autologous HSCT was 1610 days, whereas it was not reached in allogeneic HSCT. The long-lasting partnership of UIC helped building capacity and allowed Civil Service Hospital team to establish a BMT program in Nepal that has high quality standards at affordable cost for the majority of the patients.
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Affiliation(s)
| | | | | | - Simit Sapkota
- Civil Service Hospital, Kathmandu, Nepal; Kathmandu Cancer Center
| | - Subhas Pandit
- Civil Service Hospital, Kathmandu, Nepal; Kathmandu Cancer Center
| | | | | | | | - Karen Sweiss
- Blood & Marrow Transplant Program, University of Illinois at Chicago, Chicago, USA
| | - Pritesh Patel
- Blood & Marrow Transplant Program, University of Illinois at Chicago, Chicago, USA
| | - Nadim Mahmud
- Blood & Marrow Transplant Program, University of Illinois at Chicago, Chicago, USA
| | - Damiano Rondelli
- Blood & Marrow Transplant Program, University of Illinois at Chicago, Chicago, USA; Center for Global Health, University of Illinois at Chicago, Chicago, USA.
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Rocha V. Increasing access to allogeneic hematopoietic cell transplant: an international perspective. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:264-274. [PMID: 34889391 PMCID: PMC8791161 DOI: 10.1182/hematology.2021000258] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is a highly complex, costly procedure for patients with oncologic, hematologic, genetic, and immunologic diseases. Demographics and socioeconomic status as well as donor availability and type of health care system are important factors that influence access to and outcomes following allo-HCT. The last decade has seen an increase in the numbers of allo-HCTs and teams all over the world, with no signs of saturation. More than 80 000 procedures are being performed annually, with 1 million allo-HCTs estimated to take place by the end of 2024. Many factors have contributed to this, including increased numbers of eligible patients (older adults with or without comorbidities) and available donors (unrelated and haploidentical), improved supportive care, and decreased early and late post-HCT mortalities. This increase is also directly linked to macro- and microeconomic indicators that affect health care both regionally and globally. Despite this global increase in the number of allo-HCTs and transplant centers, there is an enormous need for increased access to and improved outcomes following allo-HCT in resource-constrained countries. The reduction of poverty, global economic changes, greater access to information, exchange of technologies, and use of artificial intelligence, mobile health, and telehealth are certainly creating unprecedented opportunities to establish collaborations and share experiences and thus increase patient access to allo-HCT. A specific research agenda to address issues of allo-HCT in resource-constrained settings is urgently warranted.
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Affiliation(s)
- Vanderson Rocha
- Laboratorio de Investigação Médica (LIM) 31, Serviço de Hematologia e Terapia Celular, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Eurocord, Paris, France
- Hospital Vila Nova Star - Rede D’Or, São Paulo, Brazil
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