番茄社区

SAN DIEGO – Autologous stem cell transplantation has gained initial ground in Bangladesh with the help of Boston-based practitioners, researchers reported here.

The first autologous stem cell transplant (ASCT) was performed on March 10, 2014 at Dhaka Medical College and Hospital (DMCH) and, as of May 2016, 24 patients (ages 18-58 years) have undergone the procedure at DMCH, according to , of Massachusetts General Hospital (MGH), and colleagues. The Dhaka program was developed in collaboration with MGH.

The center has treated 11 cases of multiple myeloma, four cases of Hodgkin's disease; four cases of diffuse large B-cell lymphoma, three cases of acute myeloid leukemia, and two cases of T-cell lymphoma, the authors reported in a poster at the American Society of Hematology annual meeting.

There have been no treatment-related deaths reported to date, added Sabrina Khan, MD, also at MGH. However there have been five deaths, all following disease relapse, ranging from day 213 to 598. Khan is from Bangladesh.

The long-term goal of the project is for the DMCH healthcare staff to gain the experience to treatment thalassemia, a major disease in Bangladesh and southern Asia, with allogeneic stem cell transplantation, the authors stated.

of the University of California at San Francisco, agreed that treating thalassemia is important in this part of the world.

"Thalassemia is caused by a genetic mutation that is more prevalent in that part of the world and in the Mediterranean, although we do have patients with thalassemia in the U.S.," noted Shimano, who was not involved in the study. "In patients with major thalassemia, bone marrow transplantation is curative."

Yeh said that while stem cell transplantation is an expensive and medically intensive treatment for thalassemia, it could use less resources long term versus life-long blood transfusions and associated hospital use.

"While hematopoietic stem cell transplantation has become the standard of care for many patients in developed countries, the significant economic investment, infrastructure, and healthcare provider training that are required have impeded widespread implementation in resource-constrained settings," according to the authors.

The transplant center was constructed on the top floor of the Dhaka Medical College and Hospital. It has five patient rooms, an apheresis area, hematopathology and general hematology labs, and rooms for patients with hematologic malignancies who are not currently undergoing transplantation. Three hematologists, two apheresis technicians, one lab technician, and one pharmacist participated in an exchange program, during which they each spent 2 to 3 months at MGH observing transplantation practices.

Additionally, several MGH physicians, nurses, and technologists traveled to Bangladesh and spent several weeks training staff.

Physicians were trained in diagnostics, peripheral blood stem cell collection, transfusion medicine, and management of complications. "In order to elevate the clinical competencies and professional status of the nurses in the Dhaka transplantation unit, a comprehensive curriculum for the care of these patients was developed by nurses and nurse practitioners at Massachusetts General Hospital and the [Boston-based] ," the authors explained.

They reported that engraftment occurred in all patients (range 9-16 days).

There were 10 documented infections, including seven cases of bacteremia, two Clostridium difficile infections, and one case of pneumonia.

The patient with the longest disease-free survival is now 639 days out from transplantation, the authors noted.

Shimano pointed out that, "it is a huge undertaking to set up one of these centers ... it certainly takes a lot of medical expertise in a wide variety of areas and infrastructure to set up a transplantation center."

The authors stressed that the center was able to perform its first transplants successfully within 3 years of conception because of financial, logistical, and personnel support.

"We hope that our experience will encourage more partnerships and collaborations between transplant programs in developed countries and those countries that currently lack expertise but could benefit from having this therapeutic modality available," they stated.

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