The availability of full match sibling donors and feasibility of allogeneic bone marrow transplantation in Brazil

Abstract

The feasibility of allogeneic bone marrow transplantation (alloBMT) in a developing country has not yet been demonstrated. Many adverse factors including social and economic limitations may reduce the overall results of this complex and expensive procedure. Our objective was to characterize the most important clinical, social and economic features of candidates for transplantation and their potential donors as well as the influence of these factors on overall survival in a retrospective and exploratory analysis at a university hospital. From July 1993 to July 2001, candidates for BMT were referred to the Bone Marrow Transplantation Unit by Hematology and Oncology Centers from several regions of Brazil. A total of 1138 patients were referred to us as candidates for alloBMT. Median age was 25 years (range: 2 months-60 years), 684 (60.1%) were males and 454 (39.9%) were females. The clinical indications were severe aplastic anemia and hematological malignancies. From the total of 1138 patients, 923 had HLA-typing; 497/923 (53.8%) candidates had full match donors; 352/ 1138 (30.8%) were eligible for alloBMT. Only 235 of 352 (66.7%) were transplanted. Schooling was 1st to 8th grade for 123/235 (52.3%); monthly family income ranged from US$60 (7%) to more than US$400 (36%). Overall survival for patients with chronic myeloid leukemia, severe aplastic anemia and acute myeloid leukemia was 58, 60 and 30%, respectively. Thus, overall survival rates for the most frequent hematological diseases were similar to those reported in the International Registry, except for acute myeloid leukemia. This descriptive and exploratory analysis suggests the feasibility of alloBMT in a developing country like Brazil.

Surveillance of cytomegalovirus infection in haematopoietic stem cell transplantation patients

“…39 Thus, by using N-PCR 9,16,40 and/or AGM, 13 -15 two sensitive, non-invasive and low-cost techniques for CMV detection, patients with a propensity for developing CMV disease can be readily identified and pre-emptive therapy instituted. This should allow early treatment prior to the development of significant clinical CMV disease, thereby avoiding the toxicity related to antivirals and the high cost of universal prophylaxis.…”

Análise Sociodemográfica e Clínica de Pacientes Submetidos ao Transplante Alogênico de Células-Troncos Hematopoiéticas

“…3 observou a influência econômica sobre os resultados pós-TCTH parece ser multifatorial: insumo nutricional, características da doença primária, fatores raciais, condições sanitárias e acesso a serviços de saúde devem ser considerados para determinar o prognóstico dos pacientes; além disso, notou que o risco para desenvolvimento de DECHa, a incidência de DECHc, recidiva e morte em pacientes submetidos ao TCTH eram maiores em pacientes com baixa renda. Ao contrário, estudo brasileiro prévio 23 reportou que baixa renda esteve associada a melhor sobrevida pós-TCTH. Além disso, estudos mostraram associação entre diferenças raciais e os resultados do TCTH 3,24 e altas taxas de mortalidade de crianças causadas por infecções relacionadas a condições precárias de saneamento 25 .…”

Allogeneic Hematopoietic Stem Cell Transplantation for Children and Adolescents with Acute Myeloid Leukemia in Brazil: A Multicentric Retrospective Study

“…Many patients do not undergo a proper cytogenetic and molecular evaluation and classification of their disease at diagnosis, and they may not be treated using standardized treatment protocols. In these countries, there is a limited number of hospital beds available for chemotherapy or transplantation, and optimal supportive care and management of comorbidities may not be available, compromising cure rates and increasing the risks associated with these complex and expensive procedures [13][14][15][16][17][18] .…”