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Burnouf T, Epstein J, Faber JC, Smid WM. Stepwise options for preparing therapeutic plasma proteins from domestic plasma in low- and middle-income countries. Vox Sang 2024; 119:102-109. [PMID: 37872819 DOI: 10.1111/vox.13516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 10/25/2023]
Abstract
Industrial plasma fractionation, a complex and highly regulated technology, remains largely inaccessible to many low- and middle-income countries (LMICs). This, combined with the limited availability and high cost of plasma-derived medicinal products (PDMPs), creates deficiency of access to adequate treatment for patients in resource-limited countries, and leads to their suffering. Meanwhile, an increasing number of LMICs produce surplus plasma, as a by-product of red blood cell preparation from whole blood, that is discarded because of the lack of suitability for fractionation. This article reviews pragmatic technological options for processing plasma collected from LMICs into therapies and supports a realistic stepwise approach aligned with recent World Health Organization guidance and initiatives launched by the Working Party for Global Blood Safety of the International Society of Blood Transfusion. When industrial options based on contract or toll plasma fractionation programme and, even more, domestic fractionation facilities require larger volumes of quality plasma than is produced, alternative methods should be considered. In-bag minipool or small-scale production procedures implementable in blood establishments or national service centres are the only realistic options available to gradually reduce plasma wastage, provide safer treatments for patients currently treated with non-pathogen-reduced blood products and concurrently improve Good Manufacturing Practice (GMP) levels with minimum capital investment. As a next step, when the available volume of quality-assured plasma reaches the necessary thresholds, LMICs could consider engaging with an established fractionator in a fractionation agreement or a contract in support of a domestic fractionation facility to improve the domestic PDMP supply and patients' treatment.
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Affiliation(s)
- Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | | | - Jean-Claude Faber
- Association Luxembourgeoise des Hémophiles, Luxembourg City, Luxembourg
| | - W Martin Smid
- Sanquin Consulting Services, Amsterdam and Academic Institute IDTM, Groningen, The Netherlands
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Miesbach W, Chowdary P, Coppens M, Hart DP, Jimenez-Yuste V, Klamroth R, Makris M, Noone D, Peyvandi F. Delivery of AAV-based gene therapy through haemophilia centres-A need for re-evaluation of infrastructure and comprehensive care: A Joint publication of EAHAD and EHC. Haemophilia 2021; 27:967-973. [PMID: 34553460 DOI: 10.1111/hae.14420] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Adeno-associated virus (AAV)-based gene therapy for haemophilia presents a challenge to the existing structure of haemophilia centres and requires a rethink of current collaboration and information exchange with the aim of ensuring a system that is fit-for-purpose for advanced therapies to maximise benefits and minimise risks. In Europe, a certification process based on the number of patients and facilities is offered to the haemophilia centres by European Haemophilia Network (EUHANET). AIM AND METHODS This joint European Association for Haemophilia and Allied Disorders (EAHAD) and European Haemophilia Consortium (EHC) publication describes criteria for centres participating in gene therapy care that require a reassessment of the infrastructure of comprehensive care and provides an outlook on how these criteria can be implemented in the future work of haemophilia centres. RESULTS The core definition of a haemophilia treatment centre remains, but additional roles could be implemented. A modifiable 'hub-and-spoke' model addresses all aspects associated with gene therapy, including preparation and administration of the gene therapy product, determination of coagulation and immunological parameters, joint score and function, and liver health. This will also include the strategy on how to follow-up patients for a long-term safety and efficacy surveillance. CONCLUSION We propose a modifiable, networked 'hub and spoke' model with a long term safety and efficacy surveillance system. This approach will be progressively developed with the goal of making haemophilia centres better qualified to deliver gene therapy and to make gene therapy accessible to all persons with haemophilia, irrespective of their country or centre of origin.
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Affiliation(s)
- Wolfgang Miesbach
- Medical Clinic 2, Institute of Transfusion Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Michiel Coppens
- Department of Vascular Medicine, Haemophilia Treatment Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniel P Hart
- The Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine and Dentistry, QMUL, London, UK
| | - Victor Jimenez-Yuste
- Hematology Department, Hospital Universitario La Paz, Autonoma University, Madrid, Spain
| | - Robert Klamroth
- Department for Internal Medicine and Vascular Medicine, Haemophilia Treatment Centre, Vivantes Hospital im Friedrichshain, Berlin, Germany
| | - Michael Makris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Declan Noone
- European Haemophilia Consortium, Brussels, Belgium
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre and Fondazione Luigi Villa, Milan, Italy.,Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
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Miesbach W, Pasi KJ, Pipe SW, Hermans C, O'Mahony B, Guelcher C, Steiner B, Skinner MW. Evolution of haemophilia integrated care in the era of gene therapy: Treatment centre's readiness in United States and EU. Haemophilia 2021; 27:511-514. [PMID: 33892516 DOI: 10.1111/hae.14309] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/15/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023]
Affiliation(s)
| | - K John Pasi
- Royal London Haemophilia Centre, Barts & the London School of Medicine & Dentistry, London, UK
| | - Steven W Pipe
- University of Michigan, Ann Arbor, Michigan, USA.,National Hemophilia Foundation, New York, New York, USA
| | - Cedric Hermans
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain, Brussels, Belgium
| | - Brian O'Mahony
- Trinity College, Dublin, Ireland.,Irish Haemophilia Society, Dublin, Ireland
| | | | - Bruno Steiner
- Washington Center for Bleeding Disorders at Bloodworks Northwest, Seattle, Washington, USA
| | - Mark W Skinner
- Institute for Policy Advancement Ltd, Washington, District of Columbia, USA.,McMaster University, Hamilton, Ontario, Canada
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Calizzani G, Candura F, Menichini I, Arcieri R, Castaman G, Lamanna A, Tamburrini MR, Fortino A, Lanzoni M, Profili S, Pupella S, Liumbruno GM, Grazzini G. The Italian institutional accreditation model for Haemophilia Centres. Blood Transfus 2014; 12 Suppl 3:s510-4. [PMID: 24922290 PMCID: PMC4044797 DOI: 10.2450/2014.0058-14s] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND In Italy, basic health needs of patients with inherited bleeding disorders are met by a network of 50 haemophilia centres belonging to the Italian Association of Haemophilia Centres. Further emerging needs, due to the increased life expectancy of this patient group, require a multi-professional clinical management of the disease and provide a challenge to the organisation of centres.In order to achieve harmonised quality standards of haemophilia care across Italian Regions, an institutional accreditation model for haemophilia centres has been developed. MATERIAL AND METHODS To develop an accreditation scheme for haemophilia centres, a panel of experts representing medical and patient bodies, the Ministry of Health and Regional Health Authorities has been appointed by the National Blood Centre. Following a public consultation, a technical proposal in the form of recommendations for Regional Health Authorities has been formally submitted to the Ministry of Health and has formed the basis for a proposal of Agreement between the Government and the Regions. RESULTS The institutional accreditation model for Haemophilia Centres was approved as an Agreement between the Government and the Regions in March 2013. It identified 23 organisational requirements for haemophilia centres covering different areas and activities. DISCUSSION The Italian institutional accreditation model aims to achieve harmonised quality standards across Regions and to implement continuous improvement efforts, certified by regional inspection systems. The identified requirements are considered as necessary and appropriate in order to provide haemophilia services as "basic healthcare levels" under the umbrella of the National Health Service. This model provides Regions with a flexible institutional accreditation scheme that can be potentially extended to other rare diseases.
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Affiliation(s)
| | - Fabio Candura
- National Blood Centre, National Institute of Health, Rome, Italy
| | - Ivana Menichini
- Italian Federation of Haemophilia Societies (FedEmo), Rome, Italy
- Necstep Studio Associato, Modena, Italy
| | - Romano Arcieri
- Italian Federation of Haemophilia Societies (FedEmo), Rome, Italy
| | - Giancarlo Castaman
- Department of Haematology and Haemophilia and Thrombosis Centre, San Bortolo Hospital, Vicenza, Italy
| | | | | | - Antonio Fortino
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Monica Lanzoni
- National Blood Centre, National Institute of Health, Rome, Italy
- IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Samantha Profili
- National Blood Centre, National Institute of Health, Rome, Italy
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Eshghi P, Mahdavi-Mazdeh M, Karimi M, Aghighi M. Haemophilia in the developing countries: the Iranian experience. Arch Med Sci 2010; 6:83-9. [PMID: 22371725 PMCID: PMC3278948 DOI: 10.5114/aoms.2010.13512] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 10/22/2008] [Accepted: 11/06/2008] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Management of haemophilia and inherited bleeding disorders is a major challenge especially in developing countries, because of a shortage or absence of products, the cost and the infrastructural health problems. Development of local expertise which results in an improved outlook and reduction in mortality and morbidity in these countries can be helpful for advocators in other developing countries. However, very little information on demography and organizational models for haemophilia care in developing countries are available in the literature. Our aim is a comprehensive report of haemophilia status and its management in Iran. MATERIAL AND METHODS THE MANAGEMENT CENTER OF TRANSPLANTATION AND SPECIAL DISEASES (MCTSD) OF THE MINISTRY OF HEALTH OF IRAN DECIDED TO CARRY OUT A COMPLETE REVIEW AND COMPILATION OF ALL OF THE PUBLISHED OR AVAILABLE DATA ABOUT PATIENTS WITH HAEMOPHILIA (PWH) IN IRAN: their health status, their management planning, organizations, treatment products, facilities and care problems during 2007. RESULTS 6496 patients with congenital bleeding disorders were registered. Most of them had haemophilia A and B and von Willebrand disease (vWD). However, rare bleeding disorders are seen more than expected. Inhibitor development is 14-28%. There are different data about virological status of PWH. Factor products and facilities are fairly available with more than 1.5 units per capita of inhabitant factor consumption. CONCLUSIONS A national formulary based on facilities of the country should be considered and followed by collaboration among the Ministry Of Health, universities and non-governmental organizations.
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Affiliation(s)
- Peyman Eshghi
- Paediatric Haematology and Oncology, Shahid Beheshti University of Medical Sciences; Iranian Blood Transfusion Organization, Tehran, Iran
| | - Mitra Mahdavi-Mazdeh
- Management Center of Transplantation and Special Diseases (MCTSD-MOH), Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Karimi
- Pediatric Hematology and Oncology, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Aghighi
- Management Center of Transplantation and Special Diseases (MOH), Tehran, Iran
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