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Baena JC, Rosales MC, Estacio M, Hidalgo A, Arrieta E, Jaramillo FJ, Manzi E, Parra-Lara LG, Rosales JD. Haploidentical and Matched Sibling Transplantation for Acute Myeloid Leukemia: A Hospital-Based Study. J Hematol 2023; 12:255-267. [PMID: 38188474 PMCID: PMC10769648 DOI: 10.14740/jh1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/17/2023] [Indexed: 01/09/2024] Open
Abstract
Background Allogeneic peripheral blood stem cell transplantation (PBSCT) has been increasing for the last years in Latin America. The objective of this study was to describe clinical outcomes in acute myeloid leukemia (AML) receiving allogeneic PBSCT between 2013 and 2019 in a single center of Cali, Colombia. Methods A retrospective cohort study was conducted in Fundacion Valle del Lili. Patients diagnosed with AML who received an allogeneic PBSCT between 2013 and 2019 using human leukocyte antigen (HLA)-matched sibling donors (MSDs) or haploidentical related donors (HRDs) with myeloablative conditioning regimen were included. Cases with diagnosis of promyelocytic leukemia, myelodysplastic syndrome-related AML and therapy-related AML were excluded. Data were obtained directly from the hospital PBSCT database and clinical records. Results A total of 50 patients were included (HRD, n = 32; MSD, n = 18). Sixty-two percent was in the first complete remission (CR1) at the time of the transplant, of which 26% were MSD and 74% were HRD. The European Group for Blood and Marrow Transplantation (EBMT) risk score was: 44% vs. 50% low, 28% vs. 28% intermediate and 28% vs. 22% high for MSD vs. HRD, respectively. Overall survival at 5 years for MSD was 62% (95% confidence interval (CI): 31-83%) and 43% (95% CI: 25-60%) for HRD. Event-free survival was 56% (95% CI: 26-78%) and 35.6% (95% CI: 18-53%), respectively. Non-relapse mortality at day-100 was 6% (95% CI: 0.8-35%) and 20% (95% CI: 9-39%). Relapse at5 years was 18% (95% CI: 4-58%) and 25% (95% CI: 10-52%). Overall mortality rate was 46%. The grade II-IV, III-IV acute graft-versus-host disease and severe chronic graft-versus-host disease was 44%, 11% and 12% for MSD, and 43%, 9% and 0% for HRD. Conclusion These results underline that MSD remains the first donor choice for AML patients in CR1 when available. HRDs are still our next option among alternative donors. It is necessary to find strategies that have a positive impact on those outcomes that markedly affect the quality of allogeneic PBSCT and the prognosis of patients. Comparative, randomized, prospective studies with longer follow-up of haploidentical allogeneic PBSCT with other donor types are required to definitely establish its role among alternative donors.
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Affiliation(s)
- Juan C Baena
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Hematology Service, Department of Internal Medicine, Fundacion Valle del Lili, Cali, Colombia
| | - Maria C Rosales
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Mayra Estacio
- Centro de Investigaciones Clinicas (CIC), Fundacion Valle del Lili, Cali, Colombia
| | - Alejandra Hidalgo
- Centro de Investigaciones Clinicas (CIC), Fundacion Valle del Lili, Cali, Colombia
| | - Elizabeth Arrieta
- Hematology Service, Department of Internal Medicine, Fundacion Valle del Lili, Cali, Colombia
- Bone Marrow Transplant Unit, Fundacion Valle del Lili, Cali, Colombia
| | - Francisco J Jaramillo
- Hematology Service, Department of Internal Medicine, Fundacion Valle del Lili, Cali, Colombia
- Bone Marrow Transplant Unit, Fundacion Valle del Lili, Cali, Colombia
| | - Eliana Manzi
- Centro de Investigaciones Clinicas (CIC), Fundacion Valle del Lili, Cali, Colombia
| | - Luis Gabriel Parra-Lara
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Centro de Investigaciones Clinicas (CIC), Fundacion Valle del Lili, Cali, Colombia
| | - Joaquin D Rosales
- Hematology Service, Department of Internal Medicine, Fundacion Valle del Lili, Cali, Colombia
- Bone Marrow Transplant Unit, Fundacion Valle del Lili, Cali, Colombia
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Okamoto S, Iida M, Hamad N, Duarte FB, Sureda A, Srivastava A, Galeano S, Chao N, Rondelli D, Flowers ME. American Society of Transplantation and Cellular Therapy International Affair Committee: Report of 3 rd Workshop on Global Perspective to Access to Transplantation at the 2022 Tandem Meeting. Transplant Cell Ther 2023:S2666-6367(23)01134-X. [PMID: 36921918 DOI: 10.1016/j.jtct.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Minako Iida
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Nada Hamad
- Department of Hematology, St Vincent's Hospital Sydney, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Australia; School of Medicine, Sydney, University of Notre Dame Australia
| | | | - Anna Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - Alok Srivastava
- Department of Haematology, Christian Medical College, Kilminnal, Ranipet, Tamil Nadu, India
| | | | - Nelson Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Damiano Rondelli
- Division of Hematology and Oncology; Blood & Marrow Transplant Section in the Department of Medicine at the University of Illinois College of Medicine, Chicago, IL, USA
| | - Mary E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
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3
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Iida M, Liu K, Huang XJ, Depei W, Kuwatsuka Y, Moon JH, Dodds A, Wilcox L, Ko BS, Hamidieh AA, Ho KW, Ungkanont A, Ho A, Farzana T, Sim J, Man HV, Akter M, Abeysinghe P, Bravo MR, Gyi AA, Poudyal BS, Batshkh K, Srivastava A, Okamoto S, Atsuta Y. Trends in disease indications for hematopoietic stem cell transplantation in the Asia-Pacific region: A report of the Activity Survey 2017 from APBMT. BLOOD CELL THERAPY 2022; 5:87-98. [PMID: 36713681 PMCID: PMC9873430 DOI: 10.31547/bct-2022-002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/28/2022] [Indexed: 02/01/2023]
Abstract
The Asia-Pacific Blood and Marrow Transplantation Group (APBMT) has been conducting annual surveys on the activity of hematopoietic stem cell transplants since 2007. The APBMT Data Center collected the following data in 2017. A total of 21,504 transplants were registered from 733 transplant centers of 20 countries/regions in the Asia-Pacific (AP) region. Five countries/regions comprised 89.4% of all transplants - China (6,979), Japan (5,794), South Korea (2,626), India (2,034), and Australia (1,789). The number of centers in these five countries/regions also comprised 88.9% of all centers: Japan (373), China (123), India (66), Australia (45), and South Korea (44). The overall ratio between autologous and allogeneic transplants was 37.0% and 63.0%, respectively, but the ratios varied significantly among countries/regions. Autologous transplants have surpassed allogeneic transplants in Thailand, Australia, Vietnam, New Zealand, Singapore, and Iran. In contrast, the proportion of allogeneic transplants comprised over 70% of all transplants in Pakistan, China, and Hong Kong. These ratios were compared by the Data Center among countries/regions that performed more than 50 transplants. The proportion of related and unrelated transplants also differed among countries/regions. The number of unrelated transplants was more than related ones in Japan (2,551 vs. 1,202) and Australia (329 vs. 291), whereas more than 80% of all transplants were related transplants in Malaysia (90.9%), India (89.5%), Iran (87.2%), Vietnam (85.7%), China (80.9%), and Thailand (80.6%). All transplant activities were related transplants in Pakistan, the Philippines, Myanmar, and Nepal, and no allogeneic transplants were performed in Bangladesh and Mongolia. Regarding the indications for transplants, acute myeloid leukemia (AML) was the most common disease for allogeneic transplant (4,759, 35.1% of allogeneic transplants), while plasma cell disorder (PCD) was the most common disease for autologous transplant (3,701, 27.3% of all autologous transplants). Furthermore, the number of transplants for hemoglobinopathy has steeply increased in this region compared with the rest of disease indications (677, 3.1% of all transplants). APBMT covers a broad area globally, including countries/regions with diverse disease distribution, development of HSCT programs, population, and economic power. Consistent and continuous activity surveys considering those elements in each country/region revealed the HSCT field's diverse characteristics and background factors in this region.
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Affiliation(s)
- Minako Iida
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kaiyan Liu
- Department of Hematology, Peking University Institute of Hematology, Beijing, China
| | - Xiao Jun Huang
- Department of Hematology, Peking University Institute of Hematology, Beijing, China
| | - Wu Depei
- Department of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Joon Ho Moon
- Division of Hematology-Oncology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Anthony Dodds
- St. Vincent's Pathology, St. Vincent's Health Network, Sydney, and Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), Sydney, Australia
| | - Leonie Wilcox
- Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), Sydney, Australia
| | - Bor-Sheng Ko
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Amir Ali Hamidieh
- Pediatric Cell and Gene Therapy Research Center, Gene, Cell & Tissue Research Institute, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kim Wah Ho
- Department of Hematology, Hospital Ampang, Ampang Selangor, Malaysia
| | - Artit Ungkanont
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Aloysius Ho
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Tasneem Farzana
- Department of Clinical Haematology, National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, Pakistan
| | - Joycelyn Sim
- Department of Medicine, Queen Mary Hospital, Hong Kong
| | - Huynh Van Man
- Stem Cell Transplantation Department, Blood Transfusion and Hematology Hospital, Ho Chi Minh, Vietnam
| | - Mafruha Akter
- Bone marrow transplant unit, Department of Hematology, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Prasad Abeysinghe
- Department of Oncology, National Cancer Institute, Maharagama, Sri Lanka
| | - Marjorie Rose Bravo
- St Luke's Medical Center Quezon City, IM Hematology/Blood and Marrow Transplant, Quezon, the Philippines
| | - Aye Aye Gyi
- Department of Clinical Haematology, North Okkalapa General Hospital, Yangon, Myanmar
| | - Bishesh Sharma Poudyal
- Civil Service Hospital, Clinical Hematology and Bone Marrow Transplant Unit, Kathmandu, Nepal
| | - Khishigjargal Batshkh
- Bone and Marrow transplantation team, Hematology Department, National First Central Hospital of Mongolia, Ulaanbaatar, Mongolia
| | - Alok Srivastava
- Department of Haematology, Christian Medical College Hospital, Vellore, India
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation (JDCHCT), Nagakute, Japan,Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
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Immune reconstitution after allogenic stem cell transplantation: An observational study in pediatric patients. Hematol Transfus Cell Ther 2022:S2531-1379(22)00090-6. [DOI: 10.1016/j.htct.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/18/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
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5
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Silva WF, Cysne DN, Kerbauy MN, Colturato I, Maia ACA, Tucunduva L, Barros GM, Colturato VA, Hamerschlak N, Rocha V. Predictive Factors and Outcomes after Allogeneic Stem Cell Transplantation for Adults with Acute Lymphoblastic Leukemia in Brazil. Transplant Cell Ther 2022; 28:763.e1-763.e7. [DOI: 10.1016/j.jtct.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 10/16/2022]
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6
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Viral infection in hematopoietic stem cell transplantation: an International Society for Cell & Gene Therapy Stem Cell Engineering Committee review on the role of cellular therapy in prevention and treatment. Cytotherapy 2022; 24:884-891. [PMID: 35705447 DOI: 10.1016/j.jcyt.2022.05.010] [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: 12/30/2021] [Revised: 04/13/2022] [Accepted: 05/22/2022] [Indexed: 11/20/2022]
Abstract
Despite recent advances in the field of HSCT, viral infections remain a frequent causeof morbidity and mortality among HSCT recipients. Adoptive transfer of viral specific T cells has been successfully used both as prophylaxis and treatment of viral infections in immunocompromised HSCT recipients. Increasingly, precise risk stratification of HSCT recipients with infectious complications should incorporate not only pretransplant clinical criteria, but milestones of immune reconstitution as well. These factors can better identify those at highest risk of morbidity and mortality and identify a population of HSCT recipients in whom adoptive therapy with viral specific T cells should be considered for either prophylaxis or second line treatment early after inadequate response to first line antiviral therapy. Broadening these approaches to improve outcomes for transplant recipients in countries with limited resources is a major challenge. While the principles of risk stratification can be applied, early detection of viral reactivation as well as treatment is challenging in regions where commercial PCR assays and antiviral agents are not readily available.
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7
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Increasing access to hematopoietic cell transplantation in Latin America: results of the 2018 LABMT activity survey and trends since 2012. Bone Marrow Transplant 2022; 57:881-888. [PMID: 35347244 DOI: 10.1038/s41409-022-01630-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/06/2022] [Accepted: 02/23/2022] [Indexed: 11/08/2022]
Abstract
A total of 5642 hematopoietic cell transplants (HCT) in 5445 patients (2196-40% allogeneic and 3249-60% autologous) were reported by 127 teams in 14 Latin American countries that answered the 2018 LABMT/WBMT Global Transplant Activity survey. The transplant rate (defined as the number of first transplants per 10 million inhabitants per year) was 85 (51 autologous and 34 allogeneic) in 2018. The main indications for allogeneic HCT were acute leukemias (60%), while plasma cell disorders and lymphomas were the most common conditions warranting autologous HCT (50 and 36%, respectively). In the allogeneic HCT, HLA-identical siblings were the main type of donor (44%) followed by related mismatched/haploidentical donors (32%). Peripheral blood stem cells were used in 98% of the autologous and in 64% of the allogeneic transplants. From 2012 to 2018, there was a 64% increase of reported HCT (54% in autologous and 80% in allogeneic). In the allogeneic setting, the most pronounced increase in donor type was observed in haploidentical relatives (from 94 procedures in 2012 up to 710 in 2018), surpassing unrelated donors as of 2017. Significant trends detected in Latin America include rising numbers of the procedures reported, a faster increase in allogeneic HCT compared with autologous HCT and a significant increase in family mismatched/haploidentical donors. The LABMT/WBMT activity survey provides useful data to understand the HCT activity and trends in Latin America.
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8
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Bonfim C, Nichele S, Loth G, Funke VAM, Nabhan SK, Pillonetto DV, Lima ACM, Pasquini R. Transplantation for Fanconi anaemia: lessons learned from Brazil. THE LANCET HAEMATOLOGY 2022; 9:e228-e236. [DOI: 10.1016/s2352-3026(22)00032-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 12/11/2022]
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9
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Pagnano KB, Varela AI, Pavlovsky C, Bendit I, Funke VAM, Polo VA. Challenges in Chronic Myeloid Leukemia Management in South America. Curr Hematol Malig Rep 2021; 16:440-447. [PMID: 34655027 DOI: 10.1007/s11899-021-00654-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Chronic myeloid leukemia (CML) management in developing countries has improved in the last years, but the availability of therapeutic resources, monitoring, reimbursement, and financial issues may be a challenge and interfere with the best practices and results of CML treatment. This review points out the main challenges in CML management in South America. RECENT FINDINGS In this review, we describe the access to tyrosine kinase inhibitors and monitoring in different countries of South America. We also address the ongoing discontinuation trials, the progress, and limitations of hematopoietic stem cell transplantation in the last years. There are still many challenges for achieving the best outcomes for CML patients in South America. The continuous efforts to provide continuous education, access to tyrosine kinase inhibitors, and monitoring, providing reference centers for CML management and hematopoietic stem cell transplantation may improve patients' outcomes.
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Affiliation(s)
- Katia B Pagnano
- Centro de Hematologia E Hemoterapia, Universidade Estadual de Campinas, Campinas, SP, Brazil.
| | - Ana Ines Varela
- Hospital J.M. Ramos Mejía, Sanatorio Las Lomas, Buenos Aires, Argentina
| | | | - Israel Bendit
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM/31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vaneuza A M Funke
- Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Virginia Abello Polo
- Facultad de Medicina, Fundación Universitaria de Ciencias de La Salud. Servicio de Hematología, Hospital de San José. Servicio de Hematología, Clínica del Country, Bogotá, Colombia
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Gómez SM, Varela MA, Ruiz C, Sung L. Comparable Outcomes of Matched Sibling Donor and Matched Unrelated Donor Stem Cell Transplantation in Children With Acute Leukemia in Argentina. J Pediatr Hematol Oncol 2021; 43:e1020-e1024. [PMID: 33974585 DOI: 10.1097/mph.0000000000002174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is an effective mode of consolidation therapy for children with high-risk acute leukemia. In high-income countries, match sibling donor (MSD) and match unrelated donor (MUD) HSCT have similar outcomes, but data are scarce in upper-middle-income countries. Our objective was to compare MSD and MUD HSCT outcomes for children with acute leukemia in Argentina. PATIENTS AND METHODS This was a single-institution retrospective cohort study. We included children with acute leukemia who underwent HSCT with either MSD or MUD between 2014 and 2019. RESULTS The study included 45 patients who received MSD (n=27) or MUD (n=18) for acute leukemia. Event-free survival was not significantly different between MSD (62.3±10.7%) versus MUD (54.2±15.0%; P=0.54) at 5 years. Similarly, there was no significant difference in 5-year overall survival between MSD (71.9±9.8%) versus MUD (65.1±13.5%; P=0.38). The cumulative incidence of treatment-related mortality (P=0.31), cumulative incidence of relapse (P=0.99), and proportion with acute-graft-versus-host disease (P=0.76) and chronic-graft-versus-host disease (P=0.68) were also not significantly different. CONCLUSIONS In Argentina, we did not show significant differences in outcomes between MSD and MUD HSCT for children with high-risk leukemia. Future work should focus on strategies to reduce the relapse risk in children with high-risk leukemia in upper-middle-income countries.
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Affiliation(s)
- Sergio M Gómez
- Department Stem Cell Transplantation, Hospital de Niños Sor Maria Ludovica, La Plata, Argentina
| | - Marcela A Varela
- Department Stem Cell Transplantation, Hospital de Niños Sor Maria Ludovica, La Plata, Argentina
| | - Claudia Ruiz
- Department Stem Cell Transplantation, Hospital de Niños Sor Maria Ludovica, La Plata, Argentina
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital Sick Children, Toronto, ON, Canada
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11
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The paradox of haematopoietic cell transplant in Latin America. Bone Marrow Transplant 2021; 56:2382-2388. [PMID: 33986498 DOI: 10.1038/s41409-021-01321-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/06/2021] [Accepted: 04/19/2021] [Indexed: 11/09/2022]
Abstract
Hematopoietic cells transplants are technically complex and expensive imposing a huge burden on health care systems, especially those in developing countries and regions. In 2017 > 4500 transplants were done in 13 Latin American countries with established transplant programmes. We interrogated data on transplant rate, cost, funding source, hospital type, Gini coefficient and the United Nations Development Programme Inequality-Adjusted Human Development Index to determine co-variates associated with transplant development. Transplant rates varied almost 30-fold between the 13 countries from 345 in Uruguay to 12 in Venezuela with a regional transplant rate 7-8-fold lower compared with the US and EU. We found significant correlations between higher transplant cost, public funding, transplants in private hospitals with transplant rate. Low cost per transplant regardless of payor and transplants done in public hospitals were associated with low transplant rates. In contrast, high cost per transplant funded by the government and transplants done in private hospitals were associated with high transplant rates. Surprisingly, we found transplant rates were higher when transplants cost more, when they were done in private for-profit hospitals and payed for with public funds. These data give insights how to increase transplant rates in Latin America and other developing regions.
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12
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Lack of information about umbilical cord blood banking leads to decreased donation rates among Brazilian pregnant women. Cell Tissue Bank 2021; 22:597-607. [PMID: 33576919 DOI: 10.1007/s10561-021-09903-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
The donation of umbilical cord blood (UCB) to public banks is essential to increase the probability of finding compatible donors for hematopoietic stem cell transplants. Brazil is currently the third-largest country in number of registered bone marrow donors, but it is far behind in terms of UCB donation. Thus, this questionnaire-based study aimed to assess Brazilian pregnant women's awareness, knowledge, beliefs, and opinions about UCB banking in order to identify the causes of low donation rates. Sixty-one percent of the responders were aware of UCB banking, but 86.9% of those declared to know little or very little about it. Only 14% of pregnant women were asked whether they would like to store or donate UCB. Just 13% have made a decision, and more than half decided not to donate or store it, with the leading cause being lack of knowledge. Finally, 94% of the responders believe that women should be told about UCB banking by their doctor before the last trimester of pregnancy. In conclusion, this study demonstrated that Brazilian pregnant women have insufficient knowledge about UCB banking, which affects their decision regarding UCB donation, and they wish to be better informed about it by health professionals.
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Peña C, Riva E, Schutz N, Tarín-Arzaga L, Martínez-Cordero H, Bove V, Osorio R, Chandía M, Beltrán C, Schulz J, Cardemil D, Contreras C, Vergara CG, Donoso J, Espinoza M, La Rocca G, López-Vidal H, León P, Rojas Hopkins C, Soto P, Aranda S, Torres V, Roa M, Ochoa P, Duarte PJ, Remaggi G, Yantorno S, Corzo A, Zabaljauregui S, Shanley C, Lopresti S, Orlando S, Verri V, Quiroga L, García C, Fernández V, Ramirez J, Molina A, Pacheco M, Mite A, Reyes I, Sabando B, Ramírez F, Sossa C, Abello V, Idrobo H, Galvez Cardenas KM, Saavedra D, Quintero G, Gazitúa R, Gaviria L, Gomez R, Osuna M, Henao-Uribe A, Cantú-Martínez O, Gómez-Almaguer D, García-Navarrete YI, Cruz-Mora A, Cantero-Fortiz Y, Ruiz-Argüelles GJ, Fantl D. Different outcomes for transplant-eligible newly diagnosed multiple myeloma patients in Latin America according to the public versus private management: a GELAMM study. Leuk Lymphoma 2020; 61:3112-3119. [DOI: 10.1080/10428194.2020.1804558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Eloisa Riva
- Department of Hematology, Hospital de Clínicas, Montevideo, Uruguay
| | - Natalia Schutz
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luz Tarín-Arzaga
- Hospital Universitario Dr José Eleuterio González, Monterrey, Mexico
| | - Humberto Martínez-Cordero
- Hematology and Bone Marrow Transplantation Department - Instituto Nacional de Cancerología ESE de Colombia, Bogotá, Colombia
| | | | | | | | | | | | | | | | | | | | | | | | | | - Pilar León
- Hospital Carlos Van Buren, Valparaiso, Chile
| | | | - Pablo Soto
- Hospital Regional de Puerto Montt, Santiago, Chile
| | | | | | | | - Paola Ochoa
- Instituto Alexander Fleming, Buenos Aires, Argentina
| | | | | | | | - Ariel Corzo
- Hospital de Clínicas, Buenos Aires, Argentina
| | | | | | | | | | | | - Luis Quiroga
- Department of Medicine, Hospital Churruca, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | - Virginia Abello
- Hospital de San José. Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia
| | - Henry Idrobo
- Hospital Universitario Del Valle Evaristo Garcıa E.S.E, Cali, Colombia
| | | | | | - Guillermo Quintero
- Hospital Universitario de la Fundación Santa Fe de Bogotá, Bogota, Colombia
| | - Raimundo Gazitúa
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Lina Gaviria
- Hospital Universitario San Vicente de Paul, Medellin, Colombia
| | | | | | | | | | | | - Yarely Itzayana García-Navarrete
- Clínica Ruiz, Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico
- Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
| | - Antonio Cruz-Mora
- Clínica Ruiz, Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico
- Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Yahveth Cantero-Fortiz
- Clínica Ruiz, Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico
- Universidad de las Américas Puebla, Puebla, Mexico
| | - Guillermo J Ruiz-Argüelles
- Clínica Ruiz, Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico
- Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
| | - Dorotea Fantl
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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14
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Bourlon C, Riviello-Goya S, Acosta-Medina AA, Caballero-Landinez RE, Manrique-Rubio A, Teran-De-la-Sancha K, Gulias-Herrero A, Bourlon MT. Outcomes and Challenges of Reproductive Health in Hematopoietic Stem Cell Transplantation Survivors. Biol Blood Marrow Transplant 2020; 26:2127-2131. [PMID: 32659435 DOI: 10.1016/j.bbmt.2020.07.007] [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: 05/25/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 11/19/2022]
Abstract
Long-term therapy-related reproductive health side effects impact the quality of life of hematopoietic stem cell transplantation (HSCT) survivors. In this study, we evaluated the prevalence of gonadal dysfunction (GD) pre- and post-HSCT, analyzed factors associated with GD, and explored rates of fertility assessment (FA) and fertility preservation (FP) in a resource-limited setting. FA and outcomes of patients age ≤45 years undergoing HSCT between June 2000 and May 2018 were collected retrospectively. We included 213 patients with a median age of 26 years. Pre-HSCT FA was performed in 71.8%, with a GD rate of 17%. The rate of GD was not different between the sexes (females, 19.5% versus males, 16.1%; P = .616) and was only associated with increasing age. The rate of cryopreservation in the cohort was 3.3%. Almost one-half (47.7%) of post-HSCT patients completed FA and evidenced an increase in GD rate to 48.9%. Comparing pre-HSCT and post-HSCT GD rates, women had a significant increase (19.5% versus 81.4%; P < .001), whereas men did not (16.1% versus 20.4%; P = .76). These results were confirmed by a multiple imputation analysis accounting for missing data. Female sex, pre-HSCT cytotoxic therapy, myeloablative conditioning, and germ cell tumor (GCT) diagnosis were associated with post-HSCT GD. Reproductive health preservation can be positively impacted when FA and FP are prioritized at the initial diagnosis in HSCT candidates, particularly in women of older age and men with a diagnosis of GCT. The low FP success observed urges implementation of strategies that favor accessibility and improve quality of life of HSCT survivors in low- and middle-income countries.
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Affiliation(s)
- Christianne Bourlon
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Santiago Riviello-Goya
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Aldo A Acosta-Medina
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rosa E Caballero-Landinez
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - Alfonso Gulias-Herrero
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Maria T Bourlon
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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15
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Marinho DH, Ribeiro LL, Nichele S, Loth G, Koliski A, Mousquer RTG, Funke VAM, Page K, Fasth A, Pasquini R, Boguszewski MCDS, Bonfim C. The challenge of long-term follow-up of survivors of childhood acute leukemia after hematopoietic stem cell transplantation in resource-limited countries: A single-center report from Brazil. Pediatr Transplant 2020; 24:e13691. [PMID: 32246550 DOI: 10.1111/petr.13691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/30/2020] [Accepted: 02/18/2020] [Indexed: 11/28/2022]
Abstract
With the number of long-term HSCT survivors steadily increasing, attention needs to be focused on the late complications and quality of life. We therefore analyzed the outcome of 101 pediatric patients (<18 years old at the time of HSCT) transplanted for acute leukemia between 1981 and 2015 at Complexo Hospital de Clínicas, Federal University of Paraná, Brazil, and who survived at least two years after HSCT. The median follow-up was 5.9 years (2.0-29.0); median age at follow-up was 17.5 years (2.98-39.0). The 5-year cumulative incidence of relapse was 27.5% (95% CI 18.6%-36.4%). Two-year cumulative incidence of chronic GVHD was 21.8% (95% CI 13.7%-29.8%). Of the 101 patients, 72 patients (71.3%) presented with late effects. Those surviving longer after HSCT experienced more complications. Patients who received TBI-based regimen developed more late effects (P = .013) and more endocrinological complications (P = .024). Endocrinological complications were the most common late sequelae found in this study. For childhood survivors, quality of life was not influenced by age (at HSCT or at last visit), time from HSCT, gender, donor, or GVHD. For survivors that no longer were children, only age at last visit impacted financial domain measures, irrespective of gender, donor, or GVHD. The current study confirms the high burden late complications after pediatric HSCT have on the survivors and underlines the importance of extended follow-up.
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Affiliation(s)
| | | | - Samantha Nichele
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
| | - Gisele Loth
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
| | - Adriana Koliski
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
| | | | | | - Kristin Page
- Pediatric Transplant and Cellular Therapy, Duke University, Durham, NC, USA
| | - Anders Fasth
- Department of Pediatrics, Institute of Clinical Sciencies at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ricardo Pasquini
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
| | | | - Carmem Bonfim
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
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16
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Building a hematopoietic cell transplantation outcomes registry in Mexico. Bone Marrow Transplant 2020; 55:2279-2285. [PMID: 32417853 DOI: 10.1038/s41409-020-0944-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 11/08/2022]
Abstract
The aim of this study was to assess the feasibility of hematopoietic cell transplantation (HCT) data collection using an electronic platform at Mexican centers. Four public centers performing HCT in adults were included. A cloud-based electronic platform in Spanish was developed to allow real-time registration of demographic, clinical, and outcomes variables. Data were obtained from paper and electronic medical records and institutional databases. Data managers were hired to perform the collection. Data from January 2015 to December 2018 were retro and prospectively collected during a 10-month period. From 2015 to 2018, 473 HCT were performed. Most were autologous (55%). Patients undergoing autologous HCT had the highest median age (49 years) compared with patients undergoing allogeneic (34 years) or haploidentical HCT (29 years). The most common underlying disease for autologous HCT was multiple myeloma. Acute leukemias were the most common diagnoses among allogeneic and haploidentical HCT recipients. Two-year nonrelapse mortality was 2.5%, 18%, and 18% for autologous, allogeneic, and haploidentical HCT, respectively. We determined it was feasible to start a multicenter collaborative study in Mexico as it was very well received by the physicians and it can lead to the creation of a Mexican HCT Registry in the near future.
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17
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Bourlon C, Camacho-Hernández R, Fierro-Angulo OM, Acosta-Medina AA, Bourlon MT, Niembro-Ortega MD, Gonzalez-Lara MF, Sifuentes-Osornio J, Ponce-de-León A. Latent Tuberculosis in Hematopoietic Stem Cell Transplantation: Diagnostic and Therapeutic Strategies to Prevent Disease Activation in an Endemic Population. Biol Blood Marrow Transplant 2020; 26:1350-1354. [PMID: 32200119 DOI: 10.1016/j.bbmt.2020.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/26/2020] [Accepted: 03/10/2020] [Indexed: 02/04/2023]
Abstract
Latent tuberculosis infection (LTBI) affects one-fourth of the world´s population. Hematopoietic stem cell transplantation (HSCT) recipients are at an elevated risk of developing active tuberculosis infection (ATBI). In this retrospective study of donors and HSCT recipients who underwent transplantation between February 2000 and June 2018, our aim was to determine the prevalence of LTBI and ATBI and to describe diagnostic and therapeutic strategies in an HSCT population in an endemic region. The cohort of 409 participants included 125 allogeneic HSCT (allo-HSCT) recipients, 165 autologous HSCT (auto-HSCT) recipients, and 119 HSCT donors. Patients were evaluated pre-HSCT with tuberculin skin test and thoracic imaging. LTBI was diagnosed in 26.2% of the cohort. Cases represented 20% of the auto-HSCT population, 20% of the allo-HSCT population, and 41.2% of the donor population. Pre-HSCT evaluation to rule out ATBI was performed in 62.6% of the cohort; all results were negative. Isoniazid was administered to 73.3% of those with LTBI. Within subgroups, 91.7% of HSCT recipients and 51% of donors received treatment. The median duration of therapy pre-HSCT was 70 days in recipients and 48 days in donors. The incidence of post-HSCT ATBI was 0 at 1-year follow-up. The incidence of LTBI in our population was higher than expected and still might have been underestimated owing to diagnostic test limitations. The absence of incident ATBI suggests that recipients, as opposed to donors, must receive LTBI treatment. Prevention of infectious complications in the HSCT population should be prioritized to improve clinical outcomes. Prospective data from collaborative working groups is needed to determine the best diagnostic and therapeutic approaches in this vulnerable patient population.
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Affiliation(s)
- Christianne Bourlon
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Rocío Camacho-Hernández
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Oscar M Fierro-Angulo
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Aldo A Acosta-Medina
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Maria T Bourlon
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María Dolores Niembro-Ortega
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María F Gonzalez-Lara
- Laboratory of Clinical Microbiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfredo Ponce-de-León
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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18
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Riva E, Schütz N, Peña C, Ruiz-Argüelles G, Hopkins CR, Bove V, Villano F, Andino L, Suárez L, Martínez H, Navarro J, López-Vidal H, Da Costa O, Pineda MR, Rubio Y, Ramirez J, Choque J, Fantl D. Significant differences in access to tests and treatments for multiple myeloma between public and private systems in Latin America. Results of a Latin American survey. GELAMM (Grupo de Estudio Latino Americano de Mieloma Múltiple). Ann Hematol 2020; 99:1025-1030. [PMID: 32157420 DOI: 10.1007/s00277-020-03983-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 03/01/2020] [Indexed: 12/14/2022]
Abstract
The incidence of multiple myeloma (MM) has increased in the last 20 years, particularly in middle and low-middle income countries. Access to diagnostic and prognostic tests and the availability of effective care is highly variable globally. Latin America represents 10% of the world population, distributed in countries of varied size, population, and socio-economic development. In the last decade, great improvements have been made in the diagnosis and treatment of MM. Applying these advances in real life is a challenge in our region. Local data regarding MM standards of care and outcomes are limited. A survey was carried out among hematologists from 15 Latin American countries to describe access to MM diagnostic and prognostic tests and the availability of effective care options. This study provides real-world data for MM in our region, highlighting striking differences between public and private access to essential analyses and therapeutic options.
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Affiliation(s)
- Eloísa Riva
- Hospital de Clínicas, A Italia sn, 11700, Montevideo, Uruguay.
| | - N Schütz
- Hospital de Clínicas, A Italia sn, 11700, Montevideo, Uruguay
| | - C Peña
- Hospital de Clínicas, A Italia sn, 11700, Montevideo, Uruguay
| | | | - C Rojas Hopkins
- Hospital de Clínicas, A Italia sn, 11700, Montevideo, Uruguay
| | - V Bove
- Hospital de Clínicas, A Italia sn, 11700, Montevideo, Uruguay
| | - F Villano
- Hospital de Clínicas, A Italia sn, 11700, Montevideo, Uruguay
| | - L Andino
- Hospital de Clínicas, A Italia sn, 11700, Montevideo, Uruguay
| | - L Suárez
- Hospital de Clínicas, A Italia sn, 11700, Montevideo, Uruguay
| | - H Martínez
- Hospital de Clínicas, A Italia sn, 11700, Montevideo, Uruguay
| | - J Navarro
- Hospital de Clínicas, A Italia sn, 11700, Montevideo, Uruguay
| | - H López-Vidal
- Hospital de Clínicas, A Italia sn, 11700, Montevideo, Uruguay
| | - O Da Costa
- Hospital de Clínicas, A Italia sn, 11700, Montevideo, Uruguay
| | | | - Y Rubio
- Hospital de Clínicas, A Italia sn, 11700, Montevideo, Uruguay
| | - J Ramirez
- Hospital de Clínicas, A Italia sn, 11700, Montevideo, Uruguay
| | - J Choque
- Hospital de Clínicas, A Italia sn, 11700, Montevideo, Uruguay
| | - D Fantl
- Hospital de Clínicas, A Italia sn, 11700, Montevideo, Uruguay
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19
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Oliver AC, Riva E, Mosquera R, Galeano S, Pierri S, Bello L, Caneiro A, Gai R, Miller A, Muxi P. Comparison of two different anti-infectious approaches after high-dose chemotherapy and autologous stem cell transplantation for hematologic malignancies in a 12-year period in British Hospital, Uruguay. Ann Hematol 2020; 99:877-884. [PMID: 32062742 DOI: 10.1007/s00277-020-03947-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/30/2020] [Indexed: 12/25/2022]
Abstract
Autologous stem cell transplant (ASCT) is a widely used and safe procedure to treat mostly hematologic diseases. These patients are at risk of infectious complications, which represents a major cause of morbidity and it is the second cause of mortality. This retrospective 12-year analysis of the incidence, type, and severity of infections in 266 consecutive unselected ASCT patients at our institution provides novel information addressing this issue. We included 266 ASCT procedures. Patients included in the 2006-2013 period are referred to as group 1 (ciprofloxacin prophylaxis and ceftazidime-amikacin as empirical antibiotics), and those in the 2013-2017 period are group 2 (levofloxacin prophylaxis and meropenem as empirical antibiotics). The incidence of febrile neutropenia was 72% in group 1 and 86.2% in group 2 (p = 0.004). The majority of infectious episodes were associated with fever of unknown origin: 55% in group 1 and 59% in group 2. Febrile of unknown origin episodes were 82.6% in group 1 and 80% in group 2. Significant differences between both groups were found in age, hypogammaglobulinemia, and advanced disease at ASCT. No differences were found between groups regarding the most common agent documented in positive blood cultures (Gram+ were 66.6% in group 1 and 69% in group 2 (p = 0.68)). Mortality within 100 days of transplant was low, 1.87%. Regardless of the prophylactic regimen used, most patients experience febrile episodes in the ASCT setting, fever of unknown origin is the most common infection complication, and Gram+ agents are prevalent in both groups. Mortality rates were low. According to our results, ASCT is a safe procedure and there is no clear benefit in favor of levofloxacin versus ciprofloxacin prophylaxis. Both anti-infectious approaches are acceptable, yielding similar outcomes.
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Affiliation(s)
- Ana Carolina Oliver
- Department: Hematology, Hospital Britanico, Av Italia 2420, 11300, Montevideo, Uruguay.
| | - Eloisa Riva
- Department: Hematology, Hospital Britanico, Av Italia 2420, 11300, Montevideo, Uruguay
| | - Ricardo Mosquera
- Department: Hematology, Hospital Britanico, Av Italia 2420, 11300, Montevideo, Uruguay
| | - Sebastian Galeano
- Department: Hematology, Hospital Britanico, Av Italia 2420, 11300, Montevideo, Uruguay
| | - Silvia Pierri
- Department: Hematology, Hospital Britanico, Av Italia 2420, 11300, Montevideo, Uruguay
| | - Laura Bello
- Department: Hematology, Hospital Britanico, Av Italia 2420, 11300, Montevideo, Uruguay
| | - Ada Caneiro
- Department: Hematology, Hospital Britanico, Av Italia 2420, 11300, Montevideo, Uruguay
| | - Regis Gai
- Department: Hematology, Hospital Britanico, Av Italia 2420, 11300, Montevideo, Uruguay
| | - Andrew Miller
- Department: Hematology, Hospital Britanico, Av Italia 2420, 11300, Montevideo, Uruguay
| | - Pablo Muxi
- Department: Hematology, Hospital Britanico, Av Italia 2420, 11300, Montevideo, Uruguay
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20
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Khera N, Deeg HJ, Kodish E, Rondelli D, Majhail N. Allogeneic Hematopoietic Cell Transplantation and Other Expensive Cellular Therapies: A Miracle for the Few but Off Limits to Many? J Clin Oncol 2019; 38:1268-1272. [PMID: 31730388 DOI: 10.1200/jco.19.02232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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21
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Differential admixture, human leukocyte antigen diversity, and hematopoietic cell transplantation in Latin America: challenges and opportunities. Bone Marrow Transplant 2019; 55:496-504. [DOI: 10.1038/s41409-019-0737-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 12/31/2022]
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22
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Muhsen IN, Hashmi SK, Niederwieser D, Kroeger N, Agrawal S, Pasquini MC, Atsuta Y, Ballen KK, Seber A, Saber W, Kharfan-Dabaja MA, Rasheed W, Okamoto S, Khera N, Wood WA, Koh MBC, Greinix H, Kodera Y, Szer J, Horowitz MM, Weisdorf D, Aljurf M. Worldwide Network for Blood and Marrow Transplantation (WBMT) perspective: the role of biosimilars in hematopoietic cell transplant: current opportunities and challenges in low- and lower-middle income countries. Bone Marrow Transplant 2019; 55:698-707. [PMID: 31484992 DOI: 10.1038/s41409-019-0658-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/28/2019] [Accepted: 07/05/2019] [Indexed: 12/18/2022]
Abstract
Health care costs attributed to biologics have increased exponentially in the recent years, thus biosimilars offer a possible solution to limit costs while maintaining safety and efficacy. Reducing expenditure is vital to health care especially in developing countries where affordability and access to health care is a major challenge. We discuss the opportunities and the challenges of biosimilars in the field of hematopoietic cell transplantation (HCT) in low- and lower-middle income countries. Developing countries can potentially invest in the forecasted costs reduction by utilizing biosimilars. This can be used to decrease the costs of procedures such as HCT, which is a rapidly growing field in many developing regions. The introduction of biosimilars in the developing regions faces many challenges which include, but are not limited to: legal and regulatory issues, lack of research infrastructure, and the presence of educational barriers. Thus, collaborative efforts are needed to ensure an effective and safe introduction of biosimilars into low- and lower-middle income countries.
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Affiliation(s)
- Ibrahim N Muhsen
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Shahrukh K Hashmi
- Hematology Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. .,Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Dietger Niederwieser
- Department of Hematology and Medical Oncology, University of Leipzig, Leipzig, Germany
| | - Nicolaus Kroeger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Samir Agrawal
- Division of Haemato-Oncology, Bart's Health NHS Trust and Blizard Institute, Queen Mary University of London, London, UK
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research (CIBMTR), Milwaukee, WI, USA
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
| | - Karen K Ballen
- Division of Hematology/Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Wael Saber
- Center for International Blood and Marrow Transplant Research (CIBMTR), Milwaukee, WI, USA
| | - Mohamed A Kharfan-Dabaja
- Department of Medicine, Division of Hematology-Oncology and Blood and Marrow Transplantation program, Mayo Clinic, Jacksonville, FL, USA
| | - Walid Rasheed
- Hematology Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | - Nandita Khera
- Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - William A Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Yoshihisa Kodera
- Center for Hematopoietic Stem Cell Transplantation, Aichi Medical University Hospital, Nagakute, Japan
| | - Jeff Szer
- Department of Clinical Haematology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research (CIBMTR), Milwaukee, WI, USA
| | | | - Mahmoud Aljurf
- Hematology Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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23
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Taylor M, Khan S, Stapleton M, Wang J, Chen J, Wynn R, Yabe H, Chinen Y, Boelens JJ, Mason RW, Kubaski F, Horovitz DDG, Barth AL, Serafini M, Bernardo ME, Kobayashi H, Orii KE, Suzuki Y, Orii T, Tomatsu S. Hematopoietic Stem Cell Transplantation for Mucopolysaccharidoses: Past, Present, and Future. Biol Blood Marrow Transplant 2019; 25:e226-e246. [PMID: 30772512 DOI: 10.1016/j.bbmt.2019.02.012] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/11/2019] [Indexed: 12/16/2022]
Abstract
Allogenic hematopoietic stem cell transplantation (HSCT) has proven to be a viable treatment option for a selected group of patients with mucopolysaccharidoses (MPS), including those with MPS types I, II, IVA, VI, and VII. Early diagnosis and timely referral to an expert in MPS are critical, followed by a complete examination and evaluation by a multidisciplinary team, including a transplantation physician. Treatment recommendations for MPS are based on multiple biological, sociological, and financial factors, including type of MPS, clinical severity, prognosis, present clinical signs and symptoms (disease stage), age at onset, rate of progression, family factors and expectations, financial burden, feasibility, availability, risks and benefits of available therapies such as HSCT, enzyme replacement therapy (ERT), surgical interventions, and other supportive care. International collaboration and data review are critical to evaluating the therapeutic efficacy and adverse effects of HSCT for MPS. Collaborative efforts to assess HSCT for MPS have been ongoing since the first attempt at HSCT in a patient with MPS reported in 1981. The accumulation of data since then has made it possible to identify early outcomes (ie, transplantation outcomes) and long-term disease-specific outcomes resulting from HSCT. The recent identification of predictive factors and the development of innovative regimens have significantly improved the outcomes of both engraftment failure and transplantation-related mortality. Assessment of long-term outcomes has considered a variety of factors, including type of MPS, type of graft, age at transplantation, and stage of disease progression, among others. Studies on long-term outcomes are considered a key factor in the use of HSCT in patients with MPS. These studies have shown the effects and limitations of HSCT on improving disease manifestations and quality of life. In this review, we summarize the efficacy, side effects, risks, and cost of HSCT for each type of MPS.
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Affiliation(s)
- Madeleine Taylor
- Department of Biomedical, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; Deparment of Biological Science, University of Delaware, Newark, Delaware
| | - Shaukat Khan
- Department of Biomedical, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Molly Stapleton
- Department of Biomedical, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; Deparment of Biological Science, University of Delaware, Newark, Delaware
| | - Jianmin Wang
- Department of Hematology/Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Chen
- Department of Hematology/Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Robert Wynn
- Department of Paediatric Haematology and Cell Therapy, University of Manchester, Manchester, United Kingdom
| | - Hiromasa Yabe
- Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Yasutsugu Chinen
- Department of Pediatrics, Faculty of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Jaap Jan Boelens
- Stem Cell Transplantation and Cellular Therapies, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert W Mason
- Department of Biomedical, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; Deparment of Biological Science, University of Delaware, Newark, Delaware
| | - Francyne Kubaski
- Medical Genetics Service, Hospital de ClÃnicas de Porto Alegre (HCPA), Department of Genetics and Molecular Biology- Program Partnership Graduate in Genetics and Molecular Biology (PPGBM), Federal University of Rio Grande do Sul (UFRGS), and National Institute of Populational Medical Genetics (INAGEMP), Porto Alegre, Brazil
| | - Dafne D G Horovitz
- Medical Genetics Department, National Institute of Women, Children, and Adolescent Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Anneliese L Barth
- Medical Genetics Department, National Institute of Women, Children, and Adolescent Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Marta Serafini
- Department of Pediatrics, Dulbecco Telethon Institute, University of Milano-Bicocca, Monza, Italy
| | - Maria Ester Bernardo
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele-Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Hironori Kobayashi
- Department of Pediatrics, Shimane University Faculty of Medicine, Shimane, Japan
| | - Kenji E Orii
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Yasuyuki Suzuki
- Medical Education Development Center, Gifu University, Gifu, Japan
| | - Tadao Orii
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Shunji Tomatsu
- Department of Biomedical, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; Department of Pediatrics, Shimane University Faculty of Medicine, Shimane, Japan; Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan; Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Transplantation of Hematopoietic Stem Cells for Primary Immunodeficiencies in Brazil: Challenges in Treating Rare Diseases in Developing Countries. J Clin Immunol 2018; 38:917-926. [PMID: 30470982 DOI: 10.1007/s10875-018-0564-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 10/18/2018] [Indexed: 12/21/2022]
Abstract
The results of hematopoietic stem cell transplant (HSCT) for primary immunodeficiency diseases (PID) have been improving over time. Unfortunately, developing countries do not experience the same results. This first report of Brazilian experience of HSCT for PID describes the development and results in the field. We included data from transplants in 221 patients, performed at 11 centers which participated in the Brazilian collaborative group, from July 1990 to December 2015. The majority of transplants were concentrated in one center (n = 123). The median age at HSCT was 22 months, and the most common diseases were severe combined immunodeficiency (SCID) (n = 67) and Wiskott-Aldrich syndrome (WAS) (n = 67). Only 15 patients received unconditioned transplants. Cumulative incidence of GVHD grades II to IV was 23%, and GVHD grades III to IV was 10%. The 5-year overall survival was 71.6%. WAS patients had better survival compared to other diseases. Most deaths (n = 53) occurred in the first year after transplantation mainly due to infection (55%) and GVHD (13%). Although transplant for PID patients in Brazil has evolved since its beginning, we still face some challenges like delayed diagnosis and referral, severe infections before transplant, a limited number of transplant centers with expertise, and resources for more advanced techniques. Measures like newborn screening for SCID may hasten the diagnosis and ameliorate patients' conditions at the moment of transplant.
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25
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Barth AL, Horovitz DDG. Hematopoietic Stem Cell Transplantation in Mucopolysaccharidosis Type II. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2018. [DOI: 10.1177/2326409818779097] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Anneliese L. Barth
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz – Rio de Janeiro, Brazil
| | - Dafne D. G. Horovitz
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz – Rio de Janeiro, Brazil
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Parvovirus B19 in the Context of Hematopoietic Stem Cell Transplantation: Evaluating Cell Donors and Recipients. Transplant Direct 2017; 3:e217. [PMID: 29184906 PMCID: PMC5682762 DOI: 10.1097/txd.0000000000000731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/25/2017] [Indexed: 01/07/2023] Open
Abstract
Background Parvovirus B19 (B19V) is a common human pathogen, member of the family Parvoviridae. Typically, B19V has been found to infect erythroid progenitors and cause hematological disorders, such as anemia and aplastic crisis. However, the persistence of genomic deoxyribonucleic acid (DNA) has been demonstrated in tonsils, liver, skin, brain, synovial, and testicular tissues as well as bone marrow, for both symptomatic and asymptomatic subjects. Although the molecular and cellular mechanisms of persistence remain undefined, it raises questions about potential virus transmissibility and its effects in the context of allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Methods With this aim, we retrospectively screened allogeneic stem cell donors from 173 patients admitted for allo-HSCT from January 2008 to May 2013 using a seminested polymerase chain reaction approach. Results We found 8 positive donor samples, yielding a 4.6% of parvovirus prevalence (95% confidence interval, 2.36-8.85). Pre- and post-HSCT samples (n = 51) from the 8 recipients of the positive donors were also investigated, and 1 case exhibited B19V DNA in the post-HSCT follow-up (D + 60). Direct DNA sequencing was performed to determine the genotype of isolates and classification, performed by phylogenetic reconstruction, showed a predominance of genotype 1a, whereas the rare genotype 3b was detected in 2 additional patients. By molecular cloning, different B19V 1a substrains polymorphisms were evidenced in the single case in which donor and its recipient were B19V+. Conclusions Our results suggest that HSCT allografts are not a main source for B19V transmission, pointing to potential events of reinfection or endogenous viral reactivation.
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Bonfim C, Ribeiro L, Nichele S, Loth G, Bitencourt M, Koliski A, Kuwahara C, Fabro AL, Pereira NF, Pilonetto D, Thakar M, Kiem HP, Page K, Fuchs EJ, Eapen M, Pasquini R. Haploidentical Bone Marrow Transplantation with Post-Transplant Cyclophosphamide for Children and Adolescents with Fanconi Anemia. Biol Blood Marrow Transplant 2017; 23:310-317. [DOI: 10.1016/j.bbmt.2016.11.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/03/2016] [Indexed: 11/28/2022]
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28
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Latin America: the next region for haematopoietic transplant progress. Bone Marrow Transplant 2017; 52:671-677. [DOI: 10.1038/bmt.2016.361] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 11/02/2016] [Accepted: 11/17/2016] [Indexed: 12/23/2022]
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CMV in Hematopoietic Stem Cell Transplantation. Mediterr J Hematol Infect Dis 2016; 8:e2016031. [PMID: 27413524 PMCID: PMC4928522 DOI: 10.4084/mjhid.2016.031] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 06/06/2016] [Indexed: 12/12/2022] Open
Abstract
Due to its negative impact on the outcome of stem cell transplant (SCT) and solid organ transplant patients (SOT) CMV has been called “the troll of transplantation”. One of the greatest advances in the management of SCT has been the introduction of the preemptive strategy. Since its introduction, the incidence of the viremia, as expected, remains unchanged but there has been a marked decline in the incidence of early CMV disease. However, in spite of the advances in prevention of CMV disease, CMV is still today an important cause of morbidity and mortality. Late CMV disease is still occurring in a significant proportion of patients and the so-called indirect effects of CMV are causing significant morbidity and mortality. Fortunately there have been several advances in the development of new antivirals, adoptive immunotherapy and DNA-CMV vaccines that might transform the management of CMV in the near future.
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