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Gómez-De León A, Noyola-Pérez A, Gil-Flores L, Malhotra H, Musteata V, El-Beshlawy A, Tadjoedin H, Pavlovsky C, Cortes J. Bringing global hematology research to the forefront. Blood Adv 2024; 8:3607-3611. [PMID: 38739717 DOI: 10.1182/bloodadvances.2023011873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
- Andrés Gómez-De León
- Department of Hematology, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Andrés Noyola-Pérez
- Department of Hematology, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Lourdes Gil-Flores
- Department of Hematology, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Hemant Malhotra
- Department of Medical Oncology, Sri Ram Cancer Center, Mahatma Gandhi Medical College Hospital, Jaipur, India
| | - Vasile Musteata
- N. Testemitanu State University of Medicine and Pharmacy, Discipline of Hematology, Institute of Oncology, Department of Hematology, Chisinau, Republic of Moldova
| | | | - Hilman Tadjoedin
- Department of Internal Medicine, Dharmais National Cancer Center, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Carolina Pavlovsky
- Department of Hematology and Research, Fundación de Lucha Contra la Leucemia, Buenos Aires, Argentina
| | - Jorge Cortes
- Division of Hematology/Oncology, Department of Medicine, Georgia Cancer Center at Augusta University, Augusta, GA
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Pandit S, Sapkota S, Adhikari A, Karki P, Shrestha R, Jha DS, Prajapati R, Nyaichyai KS, Poudyal BS, Poudel B, Jha AK. Breaking barriers: supporting hematopoietic stem cell transplant program through collaborative radiation therapy service from a physically distant center. J Egypt Natl Canc Inst 2024; 36:17. [PMID: 38764073 DOI: 10.1186/s43046-024-00221-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 04/06/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Total body irradiation (TBI) for hematopoietic stem cell transplant (HSCT) has certain distinct advantages, such as uniform dose distribution and lack of drug resistance, but it is not widely available in resource-constrained settings. To overcome the limitations of in-house radiotherapy services in hematology centers, we evaluated the feasibility of conducting HSCT programs in coordination with two physically distant centers using a reduced-intensity TBI protocol. METHODS Thirty-two patients with a median age of 20.5 years were included in the study. Fifteen patients were diagnosed with aplastic anemia, 10 patients with acute myeloid leukemia (AML), 3 patients with acute lymphocytic leukemia (ALL), and 4 patients with other hematological conditions. Conditioning regimens used were fludarabine plus cyclophosphamide in 29 cases, fludarabine-cytarabine ATG in 2 cases, and busulfan plus fludarabine in 1 case. The TBI dose was 3 Gy in 28 cases and 2 Gy in 4 cases. Patients were followed monthly after TBI, and the major toxicities were recorded. RESULTS The median follow-up was 22 months. The most common acute complication was acute graft-versus-host disease (GVHD), which occurred in 15.6% of patients. The major late complications were chronic GVHD (9.3%), Cytomegalovirus (CMV) infection (34.3%), and CMV-induced secondary graft failure (6.2%). Seventy-five percent of patients were alive, 21.9% were dead, and 1 patient was lost to follow-up. CONCLUSIONS HSCT based on TBI is feasible even if the center lacks a radiotherapy facility by coordinating with a remote radiotherapy facility. without compromising the patient's outcome.
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Affiliation(s)
- Subhas Pandit
- Department of Clinical Oncology, Kathmandu Cancer Center, Tathali, Bhaktapur, Nepal.
| | - Simit Sapkota
- Department of Clinical Oncology, Kathmandu Cancer Center, Tathali, Bhaktapur, Nepal
| | - Abish Adhikari
- Department of Radiation Oncology, Kathmandu Cancer Center, Tathali Bhaktapur, Nepal
| | - Prakriti Karki
- Department of Research, Kathmandu Cancer Center, Tathali, Bhaktapur, Nepal
| | - Roshani Shrestha
- Department of Radiation Oncology, Kathmandu Cancer Center, Tathali Bhaktapur, Nepal
| | - Deepak Suman Jha
- Department of Radiation Oncology, Kathmandu Cancer Center, Tathali Bhaktapur, Nepal
| | - Rajan Prajapati
- Department of Radiation Oncology, Kathmandu Cancer Center, Tathali Bhaktapur, Nepal
| | | | - Bishesh Sharma Poudyal
- Clinical Hematology and Bone Marrow Transplant Unit, Civil Service Hospital, Minbhawan, Kathmandu, Nepal
| | - Bishal Poudel
- Medical Oncology Unit, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Anjani Kumar Jha
- Department of Radiation Oncology, Kathmandu Cancer Center, Tathali Bhaktapur, Nepal
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Akram A, Gilani M, Chaudhry QUN, Iftikhar R, Ghafoor T, Khan MA, Haider M, Nisar H. Real-World Challenges of Haplo-Identical Hematopoietic Stem Cell Transplant in a Developing Country: A Single Center Experience. Cureus 2024; 16:e59744. [PMID: 38841039 PMCID: PMC11152362 DOI: 10.7759/cureus.59744] [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: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Hematopoietic stem cell transplant (HSCT) is potentially, the sole curative option for many malignant and non-malignant hematological disorders. Finding a human leukocyte antigen (HLA) compatible donor remains one of the limiting factors, hampering the utilization of HSCT. However, the introduction of post-transplant cyclophosphamide (PTCy) has improved the outcomes of haploidentical transplants making it a suitable option for patients lacking HLA-compatible donors. We collected data from 44 patients who underwent haplo-identical allogeneic stem cell transplants at the Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant (AFBMTC/NIBMT) from the year 2015 to 2022. The diseases were divided into three categories, i.e., bone marrow failure (BMF) syndromes, hematological malignancies (HM) and miscellaneous (Misc) groups. Median age at transplant was 18 (01-39) years. Transplant indications included aplastic anemia (AA) in 21 (47.7%) cases, 15 (34.1%) HM, and eight (18.2%) cases falling in the Misc groups. A maximum number of graft failures occurred in the BMF group; primary graft failure in 07 (33.3%) cases and secondary graft failure in four (19%) cases, (p-value < 0.05). Acute graft versus host disease (aGVHD) grade II-IV occurred in nine (20.5%) cases while chronic graft versus host disease (cGVHD) occurred in 10 (22.7%) cases. Cytomegalovirus (CMV) reactivation was seen in 31 (70.5%) cases. Maximum CMV reactivation was seen in HM group 13 (86.6%) cases, (p-value < 0.05) as compared to BMF (71.4%) and Misc groups (37.5%). Post-transplant cyclophosphamide (PTCy) based regimens, early neutrophil engraftment, and patients with GVHD had better survival outcomes (p-value < 0.05) overall survival (OS), and relapse-free survival (RFS). and GVHD-free relapse-free survival (GFRS) were significantly better in cases with early neutrophil engraftment. OS of the study cohort was 50% while disease-free survival (DFS) and GFRS were 45.5% and 36.4%, respectively.
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Affiliation(s)
- Ammad Akram
- Clinical Hematology, Armed Forces Bone Marrow Transplant Center, Rawalpindi, PAK
| | - Mehwish Gilani
- Chemical Pathology, Armed Forces Bone Marrow Transplant Center, Rawalpindi, PAK
| | | | - Raheel Iftikhar
- Hematology and Oncology, Armed Forces Bone Marrow Transplant Center, Rawalpindi, PAK
| | - Tariq Ghafoor
- Pediatrics, Armed Forces Bone Marrow Transplant Center, Rawalpindi, PAK
| | - Mehreen Ali Khan
- Hematology, Armed Forces Bone Marrow Transplant Center, Rawalpindi, PAK
| | - Memoona Haider
- Hematology, Armed Forces Bone Marrow Transplant Center, Rawalpindi, PAK
| | - Haider Nisar
- Clinical Hematology, Armed Forces Bone Marrow Transplant Center, Rawalpindi, PAK
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Pudasaini P, Paudel S, Sagar GC, Adhikari S, Thapa N, Thapa B. Extensive acute cutaneous graft versus host disease: A rare case report of survival. Clin Case Rep 2023; 11:e7545. [PMID: 37323259 PMCID: PMC10264954 DOI: 10.1002/ccr3.7545] [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] [Received: 05/10/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
Graft versus host disease (GVHD) is an immunologically mediated condition seen in allogeneic hematopoietic stem cell transplant (HSCT) recipients. Because of the rarity of the disease, nonspecific presentation, and lack of clinicopathological correlation, its diagnosis is often delayed and prompt treatment is deferred, with increased mortality.
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Affiliation(s)
| | - Sushil Paudel
- Department of DermatologyCivil Service HospitalKathmanduNepal
| | - G. C. Sagar
- Department of DermatologyCivil Service HospitalKathmanduNepal
| | | | - Neeraj Thapa
- Nepal Medical College Teaching HospitalKathmanduNepal
| | - Bibechan Thapa
- Department of Emergency and Inpatient CareNepal National HospitalKathmanduNepal
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Sharma Poudyal B, Devkota A, Kouides P. Thalassemia care in Nepal: In dire need of improvement. EJHAEM 2023; 4:548-550. [PMID: 37206294 PMCID: PMC10188498 DOI: 10.1002/jha2.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 05/21/2023]
Affiliation(s)
| | | | - Peter Kouides
- Mary M. Gooley Hemophilia CenterRochesterNew YorkUSA
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Jaimovich G, Lazarus HM, Gale RP. Hematopoietic cell transplants in resource-poor countries: challenges and opportunities. Expert Rev Hematol 2023; 16:163-169. [PMID: 36919565 DOI: 10.1080/17474086.2023.2191946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Numbers of hematopoietic cell transplants continue to increase globally but most of this activity is in resource-rich countries. Limitations to increasing transplant activity in resource-poor countries include lack of sophisticated personnel and infrastructure, complexity in identifying and accessing donors, unavailability of some new drugs and high cost. AREAS COVERED We searched the biomedical literature for hematopoietic cell transplants and resource-rich and resource-poor countries. Recent advances which potentially make transplants more accessible in resource-poor countries include: (1) outpatient transplants; (2) grafts stored at 4°C; (3) less intensive pretransplant conditioning; (4) use of generic drugs; (5) less complex and costly donor access; and (6) increased collaboration with transplant centers in resource-rich countries. EXPERT OPINION We reviewed publications on the limitations and solutions discussed above. Paradoxically, most data we analyzed originate from resource-rich countries. We found no convincing epidemiological data to support a recent increased transplant rate in resource-poor countries yet but hope to see increases soon.
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Affiliation(s)
- Gregorio Jaimovich
- Department of Bone Marrow Transplantation, Favaloro University Hospital, Buenos Aires, Argentina
| | - Hillard M Lazarus
- Department of Medicine, Division of Hematology and Oncology, Case Western Reserve University, Cleveland, OH, USA
| | - Robert Peter Gale
- Centre for Haematology, Department of Immunology and Inflammation, Imperial Collage London, London, UK
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Banday SZ, Guru F, Ayub M, Ahmed SN, Banday AZ, Mir MH, Nisar R, Hussain S, Bhat GM, Aziz SA. Long-Term Outcomes of Autologous Hematopoietic Stem Cell Transplant (HSCT) for Multiple Myeloma: While New Horizons Emerge, It Is Still Only a Silver Lining for Resource-Constrained Settings. Cureus 2023; 15:e36642. [PMID: 37155458 PMCID: PMC10122934 DOI: 10.7759/cureus.36642] [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: 03/22/2023] [Indexed: 05/10/2023] Open
Abstract
Background Significant hurdles impede the optimal implementation of hematopoietic stem cell transplantation (HSCT) in low-middle income countries (LMICs). Herein, we highlight the challenges faced in LMICs while performing HSCT and report the long-term outcomes of patients with newly diagnosed multiple myeloma (MM) who underwent autologous HSCT (AHSCT) at our center. Besides, we provide a comprehensive review of studies reporting long-term outcomes of AHSCT in MM from the Indian subcontinent. Methodology This study was conducted at the State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India. Case records of all patients with MM who received AHSCT from December 2010 to July 2018 were reviewed retrospectively. A non-systematic literature search was performed using PubMed and Google Scholar databases. Data regarding clinicopathological parameters and long-term follow-up were extracted from relevant studies and for patients included in our study. Results At our center, 47 patients (median age 52.0 years) with MM underwent AHSCT. Majority of patients had stage III disease (ISS) and median time to transplant was 11.5 months. The five-year progression free survival (PFS) and overall survival (OS) were 59.1% and 81.2%, respectively. Studies from the Indian subcontinent have observed a five-year OS of ~50% to ~85%. However, a greater variability in the five-year PFS has been reported, ranging from ~20% to ~75%. The median time to transplant has ranged from seven to 17 months (indicating time delays) with median CD34 cell counts of 2.7-6.3×106 cells/kg (lower than developed countries). Conclusions Despite significant resource limitations in LMICs, AHSCT is increasingly been performed in MM with encouraging long-term outcomes.
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Affiliation(s)
- Saquib Z Banday
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Faisal Guru
- Department of Medical Oncology, Pediatrics Unit, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Maniza Ayub
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Syed N Ahmed
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Aaqib Z Banday
- Department of Pediatrics, Government Medical College, Srinagar, IND
| | - Mohmad H Mir
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Rahila Nisar
- Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Saleem Hussain
- Department of Laboratory Hematology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Gull M Bhat
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Sheikh A Aziz
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
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Chen M, Liu Y, Yang X, Hong Y, Ni J. Cost analysis of childhood hematopoietic stem cell transplantation in Sichuan, China. Front Public Health 2023; 11:990181. [PMID: 37033079 PMCID: PMC10076710 DOI: 10.3389/fpubh.2023.990181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Objective To analyze the inpatient cost of hematopoietic stem cell transplantation (HSCT) in children, so as to support clinical decision-making. Methods Study population were children who received HSCT in a tertiary children's hospital (Sichuan, China) between 1st January 2020 and 31st December 2021. The median and interquartile range (IQR) of total cost at 100 days post transplantation were calculated. Subgroup analyses were conducted based on age, gender, transplantation types, and post-transplant complications. The cost differences between subgroups were analyzed to determine whether it had an impact on the total costs. Results A total of 142 pediatric patients were included in the study with a total cost of 250721.78 yuan (197019.16-315740.52, 1 yuan equals to around 0.15 US dollars). Drug costs accounted for 51.85% of the total cost, followed by medical service costs (12.57%) and treatment expenses (12.24%). In terms of transplantation types, the cost of autologous transplantation was lower than that of allogeneic transplantation (115722.98 yuan vs. 256043.99 yuan, p < 0.05), and the cost of human leukocyte antigen (HLA) complete matched was lower compared with that of partial matched (213760.88 yuan vs. 294044.84 yuan, p < 0.05). As for post-transplant complications, cases with <3 types of complications cost less than those with ≥3 types (212893.25 yuan vs. 286064.60 yuan, p < 0.05), and those with severity ≤ grade 2 cost less than those > grade 2 (235569.37 yuan vs. 280061.58 yuan, p < 0.05). Age and gender of patients did not lead to statistical differences in the total cost, while the transplantation types and post-transplant complications influenced the total cost. Conclusion The total cost at 100 days post transplantation associated with HSCT treatment were substantial for pediatric patients. The HLA compatibility between donors and recipients, and post-transplant complications were important factors affecting the total cost.
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Affiliation(s)
- Min Chen
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yantao Liu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xue Yang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Department of Pediatric Hematology and Oncology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yu Hong
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Jiaqi Ni
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
- *Correspondence: Jiaqi Ni,
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Poudyal BS, Dulal S, Shilpakar R, Gyawali B. Highlights from ecancer Choosing Wisely Nepal 2022: critical appraisal skills for evidence-based practice, 24th-25th September 2022, Kathmandu, Nepal. Ecancermedicalscience 2022; 16:1478. [PMID: 36819797 PMCID: PMC9934887 DOI: 10.3332/ecancer.2022.1478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Indexed: 11/29/2022] Open
Abstract
The ecancer Kathmandu 2022 workshop on the 24th-25th September 2022 was the first ecancer conference organised in Nepal, a Southeast Asian nation sandwiched between India and China. It was focused on critical appraisal skills for evidence-based practice and was organised in partnership with the Karnali Academy of Health Sciences and the Civil Service Hospital from Nepal, and the Queen's Global Oncology Program from Canada. The workshop emphasised the need for critical thinking in understanding clinical research, and also motivated the delegates to undertake meaningful clinical research relevant to the local setting. The sessions highlighted the features of a good clinical research, identify pitfalls in the reporting of clinical trials, implementation of the research into locally relevant practice and development of local clinical guidelines. Furthermore, the faculty also discussed how to write a good scientific paper, the do's and don'ts of a systematic review and meta-analysis, the role of peer-review and how to do one properly and what do editors look for in evaluating papers submitted for publication. The audience learned the importance of finding a good mentor and fostering local and international collaboration. The local faculty also highlighted their own personal journeys and how mentorship and global collaboration played an important role in their own academic career. The enthusiastic panel discussion was a highlight of the programme where the delegates learned about several important topics from the faculties, such as work-life balance, the role of mentorship in building careers and building networks.
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Affiliation(s)
- Bishesh Sharma Poudyal
- Clinical Hematology and Bone Marrow Transplant Unit, Department of Medicine, Civil Service Hospital, Kathmandu 44600, Nepal
| | - Soniya Dulal
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan 56700, Nepal
| | - Ramila Shilpakar
- Department of Clinical Oncology, National Academy of Medical Sciences, Bir Hospital, Kathmandu 44600, Nepal
| | - Bishal Gyawali
- Queen’s Global Oncology Program, Department of Oncology, Queen’s University, Kingston, ON K7L 3N6, Canada,Division of Cancer Care and Epidemiology, Queen’s Cancer Research Institute, 10 Stuart Street, Level 2, Queen’s University, Kingston, ON K7L 3N6, Canada
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Dey BR, Yeh AC, Spitzer TR. Establishing the First Hematopoietic Stem Cell Transplant Unit in Nepal. Transplant Cell Ther 2022; 28:223-224. [PMID: 35523473 DOI: 10.1016/j.jtct.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Albert C Yeh
- Fred Hutchinson Cancer Center, University of Washington
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