Narrowing the gap for hematopoietic stem cell transplantation in the East-Mediterranean/African region: comparison with global HSCT indications and trends

Abstract

Hematopoietic Stem Cell Transplantation (HSCT) activity was evaluated in the African (AFR)/EMRO region and compared to the global activity for the years 2006-2013. Data were obtained from 1570 teams in the 6 WHO continental regions. Of these, 29 (1.85%) of all teams were active in 12 of the 68 AFR/EMRO countries. They reported 2.331 (3.3%) of the worldwide 71.036 HSCT, and a transplant rate of 32.8 (TR; HSCT/10 million inhabitants; worldwide 128.5). This reflects still the lowest regional TR despite an increase of 90% since 2006. HSCT activity in AFR/EMRO countries was characterized by a higher use of allogeneic compared to autologous HSCT, an almost exclusive use of family donors, including haploidentical family donors. These findings contrast with the prevalence of autologous over allogeneic HSCT, and a higher frequency of unrelated HSCT in other parts of the world. Of note, the increase by 200% in HSCT for hemoglobinopathies from 2006 to 2013 (72 per year) in the AFR/EMRO region. This reflects the specific role of HSCT for these disease categories with high prevalence and incidence in the AFR/EMRO region. This report provides information for the competent authorities to foster adequate infrastructure. It urges transplant organization to optimize their cooperation.

Hematopoietic cell transplants in Jordan: different indications from the US and EU

“…For example, there was a greater proportion of allotransplants for Hodgkin than non-Hodgkin lymphomas. These data are like those reported by the Eastern Mediterranean Bone Marrow Transplant Group (EMBMT) but different than those reported by the Center for Blood and Marrow Research (CIBMTR) [10]. There was a greater proportion of allotransplants for haemoglobinopathies probably because of the increased incidence in the Middle East including Jordan.…”

“…If we include the 100 transplants for immune deficiency reported telephonically the proportion of such transplants is 13%, much higher than in the US and EU (6%). Most recipients were referred from neighbouring Arab countries [10]. There were also differences in autotransplant indications with twice as many for Hodgkin versus non-Hodgkin lymphomas.…”

Heterogeneity of cell therapy products

“…Global surveys show a 90% increase overall in HSCT in the World Health Organization (WHO)'s African and Eastern Mediterranean regions from 2006 to 2013, with a 69% and 129% increase in allogeneic and autologous transplants, respectively. [15] The CD34 cell surface marker is primarily used to identify, isolate and enumerate HSPCs. [16] Isolated CD34 + HSPCs are a heterogeneous population, which includes both primitive haematopoietic stem cells (HSCs) and early-and late-stage progenitors (Fig.…”

Worldwide Network for Blood and Marrow Transplantation Recommendations for Establishing a Hematopoietic Cell Transplantation Program, Part I: Minimum Requirements and Beyond

“…Fundamental elements necessary for establishing a transplantation program were developed during these workshops; however, it became evident that these elements were highly dependent on the prevalence of diseases in different regions and on available resources [6][7][8][9]. These factors drive the types of transplantations needed locally and determine what is affordable or economically feasible [10].…”