Haematopoietic stem cell transplantation in South Africa: Current limitations and future perspectives

Abstract

Allogeneic haematopoietic stem cell transplantation (HSCT) involves the transfusion of donor haematopoietic stem and progenitor cells (HSPC) procured from bone marrow, peripheral blood or the umbilical cord into a suitably primed recipient. Autologous haematopoietic stem cell transplantation, on the other hand, denotes the collection of the patient's own stem cells prior to high-dose myeloablative chemotherapy, which are subsequently re-infused as a stem cell rescue to facilitate recovery of the marrow function. HSCT was pioneered by E D Thomas in 1957. [1] At that time, this procedure provided the first evidence that bone marrow had the capacity to regenerate the haematopoietic system and effectively treat or alleviate disorders of the same origin. Since 1957, HSCT has formed part of the treatment regimen of more than one million patients. [2] The European Group of Blood and Marrow Transplantation (EBMT) annually conducts a survey on HSCT activity in order to observe and monitor trends in Europe and affiliated countries. Data collected by these surveys provide evidence on the growing need for this procedure, with the number of HSCTs performed annually increasing from 4 234 in 1990 to over 40 000 in 2017. [3] There are no statistics currently available for the number of transplants performed in South Africa (SA), nor data reporting the need for this treatment or patient burden, and thus the deduction of an increased demand can be made on observed global trends. Schonfeld et al. [4] reported that 14 662 patients were diagnosed with haematological malignancies between 2000 and 2006, being responsible for 6% of the new cancer diagnoses and 8% of the cancer deaths reported in SA. These data were collected from the National Cancer Registry, which has certain caveats in that there may be underreporting of these cancers owing to diagnostic and reporting challenges in rural and lower socioeconomic communities. A regional study conducted by Oelofse and Truter [5] found that haematological malignancies were not uncommon in Eastern Cape Province, and the incidence was comparable to some European populations. Additionally, certain black and Afrikaner population groups of SA are at greater risk of inheriting Fanconi's anaemia owing to the genetic founder effect of the mutant Fanconi-associated genes. [6] Indications for the procedure have expanded to encompass treatment of not only haematological and non-haematological malignancies, but also congenital and other acquired disorders of the haematopoietic system, as well as autoimmune and hereditary diseases (Table 1). [7] Based on data collected from the World Health Organization (WHO)-defined global regions, Gratwohl et al. [2] reported that 58% of all HSCTs performed were autologous whilst 42% were allogeneic. Furthermore, the highest number of HSCTs were performed in Europe, followed by the Americas, Southeast Asia and the Western Pacific. The lowest number of HSCTs were performed in Eastern Mediterranean countries and Africa. Additionally, HSCTs were not carried out in coun...

Pulmonary acute graft‐versus‐host disease and infections after allogeneic hematopoietic stem cell transplantation in pediatric recipients: A comparative study on CT

“…The number and ratio of allo‐HSCT in pediatric recipients increase annually worldwide especially in developing countries 4‐6 . Therefore, the management of pulmonary complications becomes more essential.…”

“…The number and ratio of allo-HSCT in pediatric recipients increase annually worldwide especially in developing countries. [4][5][6] Therefore, the management of pulmonary complications becomes more essential. Among the non-infectious complications, graft-versus-host disease (GVHD) remains a major cause of morbidity and mortality and a key to success of HSCT.…”