Provision of Peripheral Blood Stem Cell Service in Developing World: Experience from a Private Medical Center in Malaysia.

Abstract

Stem cell transplants (SCT) are potentially life-saving procedures but the availability of such services is limited in the government sector in Malaysia. The cost and logistics of having SCT abroad are daunting. This paper outlined our experience in setting up a SCT unit in a private hospital and reporting on the first hundred cases done over a 4 and a half year period from 1999 to 2004. All cases of SCT were performed with peripheral blood stem cells and in 5 cases (5%) back- up marrow was necessary as <2X10^6 per kg of CD34 positive PBSC was harvested. Autologous SCT was performed on 66 cases for the following indications i.e. Non Hodgkin’s lymphoma (37), Acute myeloid Leukemia (13), multiple myeloma (10) and Hodgkin’s lymphoma (6). Thirty four allogeneic SCT were performed for AML (16), chronic myeloid leukemia (8), acute lymphoblastic leukemia (4), Non Hodgkin’s lymphoma (4), Myelodysplastic syndrome (1) and aplastic anaemia (1). Twenty of the allografts were conventional SCT while 14 had reduced intensity allografts. Transplant related mortality (TRM) was recorded in 4 cases (13.6%) of allogeneic SCT. Three of the deaths were sepsis related. No TRM was seen in autologous SCT. The direct medical cost (included stem cell harvest and the first 3 months post transplant care) of autologous SCT was a mean of US$ 16000 (ranged from US$ 9000 to US$ 20000) while allogeneic SCT cost a mean of US$ 25000 (ranged from US$ 20000 to US$ 60000). Our experiences indicated that SCT is feasible in a private medical center in a developing nation—the SCT results were comparable with established centers but with substantial cost saving as compared with SCT done abroad.