HSCT is the only curative option for many malignant and non-malignant diseases. The WBMT was founded as an umbrella organization of societies involved in cellular therapies with the mission of promoting excellence in HSCT. As a non-governmental organization in official relation with the World Health Organization (WHO), the WBMT assisted in the founding of regional societies (Latin America Blood and Marrow Transplantation Group and African Blood and Marrow Transplantation Group), performs global activity surveys, conducts workshops and provides expert support for programs in evolving countries. In this retrospective evaluation we analyzed worldwide activity trends in HSCT up to the year 2016 and evaluated possibilities of improving availability of HSCT by the use of telemedicine. Methods: HSCT activity was collected annually from member societies, national registries and individual centers including donor type (allogeneic/autologous), stem cell source (bone marrow/peripheral blood stem cells/cord blood) and indications for transplant. Transplant rates (TR) were calculated as HSCT/10 million inhabitants without adjustment for patients transplanted in a country other than that of primary residence. Country team density (TD) was defined as teams/10 million inhabitants. Workshops were organized in a number of locations where there was little or no HSCT activity or where improvement in one or more aspect of local or regional HSCT activity was requested, including Vietnam, Brazil, China, South Africa and Morocco. Other countries were paired with established centers using WBMT affiliated partners. In two countries, a pilot program was established involving a 6 month physician training in a JACIE/FACT accredited center followed by daily telemedicine-guided supervision of clinical activities. Results: From 1957-2016 a total of 1,298,897 HSCT (57.1% autologous) procedures were collected. By the end of 2016, HSCT activity was reported from 87 of the 195 WHO member states. A total of 89,070 HSCT from 1662 centers was reported in 2016. Assuming a frequency of 84,000/year, 1.5 million HSCT will be reached in 2019, only 7 years after the 1 million report in 2012 (Figure 1). The global activity/year increased continuously from 10,000/year in 1991 to 82,718 first HSCT/year in 2016 with a global increase of >7% (7.0% in autologous and 7.8% in allogeneic HSCT). As in previous years, slightly more autologous (53.5%) than allogeneic and more related (53,6%) than unrelated HSCT were reported. The further increase in related HSCT was caused mainly by an increase of non-identical family donors (39.5% of related HSCT). Increase in activities according to regions is given in Figure 2. TR and TD varied according to region and are highest in Nord America with 511.2 TR, followed by Europe with 390.9 TR, Latin America with 63.9 TR, APBMT with 46.2 TR and Africa/EMRO with 32.8 TR. In contrast, TD was highest in Europe (7.5 TD) followed by Nord America (6.0 TD), APBMT (1.9 TD), Latin America (1.9 TD) and Africa/EMRO (0.4 TD). Commonest indications were lymphoproliferative diseases for autologous and leukemia for allogeneic HSCT and continue to rise (Figure 3 autologous and Figure 4 allogeneic HSCT). Graft source were predominantly peripheral blood in autologous (99.7%) and 65% in unrelated HSCT, while umbilical cord blood as a stem cell source (13.8% of all unrelated) declined. More than 150 HSCT were performed in one country and one center without activities using daily telemedicine-guided supervision. In conclusion, the global distribution and activities are increasing continuously by more than 7,0% per year with numbers currently running at app. 90,000/year. Of note is the increase of haploidentical HSCT activity, while the use of umbilical cord blood HSCT continues to decrease. TR data show significant gaps between regions. Supervisory telemedicine is a powerful tool to overcome lack of experience and establish JACIE/FACT compatible new programs with collateral benefits for conventional hematology, blood banking, microbiology and virology. Abbreviations: EUR, Europe; AMR/PHA, America; SEAR/WPR, South-East Asia/Western Pacific; AFR/EMRO, African/Eastern Mediterranean. Disclosures Niederwieser: Daichii: Speakers Bureau; Cellectis: Consultancy. Atsuta:Kyowa Kirin Co., Ltd: Honoraria; Chugai Pharmaceutical Co., Ltd.: Honoraria; Mochida Pharmaceutical Co. Ltd: Honoraria; Janssen Paharmaceutical K.K.: Honoraria. Worel:Sanofi Genzyme, Malinckrodt Therakos: Research Funding; Jazz, Sanofi, Celgene, Novartis, Malinckrodt Therakos: Honoraria; Sanofi Genzyme, Malinckrodt Therakos: Speakers Bureau. Galeano:Szabo SA: Other: (Equity interest). Novitzky:Astellas, Roche: Consultancy. Szer:Prevail Therapeutics: Honoraria, Other: Travel, Research Funding; Novartis: Honoraria, Other: Travel, Research Funding; MSD: Honoraria, Other: Travel, Research Funding; Celgene: Honoraria, Other: Travel, Research Funding; Amgen: Honoraria, Other: Travel, Research Funding; Alexion: Honoraria, Other: Travel, Research Funding; Sanofi: Honoraria, Other: Travel, Research Funding; Takeda: Honoraria, Other: Travel, Research Funding; Pfizer: Honoraria, Other: Travel, Research Funding. Kröger:Celgene: Honoraria, Research Funding; DKMS: Research Funding; JAZZ: Honoraria; Medac: Honoraria; Neovii: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Riemser: Research Funding; Sanofi-Aventis: Research Funding. Weisdorf:Incyte: Research Funding; Pharmacyclics: Consultancy; Fate Therapeutics: Consultancy. Pasquini:Amgen: Consultancy; BMS: Research Funding; Medigene: Consultancy; Pfizer: Other: Advisory Board; Novartis: Research Funding; Kit Pharma: Research Funding.
The first meeting of the African Blood and Marrow Transplantation (AfBMT) was held in Casablanca from April 19, 2018 to April 21, 2018, with the aim of fostering hematopoietic stem cell transplantation (HSCT) activity in Africa. Out of the 54 African countries, HSCT is available only in six (Algeria, Egypt, Morocco, Nigeria, South Africa, and Tunisia). During this meeting, African teams and international experts from the Worldwide Network for Blood and Marrow Transplantation (WBMT) gathered to share their experience and discussed ways to help fill the gap. Nurses and patients held their meeting in parallel. International support and collaboration can help by providing expertise adapted to local resources and regional population needs. Local engagement including government and private participants are necessary to initiate and develop local HSCT capability.
Introduction: Chronic lymphocytic leukemia (CLL) is the most frequent leukemia of the adult in Europe and North Africa. It is rare on the Asian and African continents. It affects mainly elderly people over 60 years. The main objective is determining the rate of average annual incidence, and secondly establishing the distribution of this complaint according to the different health regions of the country and precise the epidemiological characteristics. Patients and Methods: It is a national, descriptive, retrospective epidemiological study carried out for a period of 05 years : from January 2009 to December 2013. Information collection is done thanks to the setting up of a technical data sheet sent out to the appropriate services. This technical data sheet is about the geographic data of the patient (place of birth, place of residence, place of taking charge of the disease and the date of the diagnosis), anthropologic data (age at the diagnosis, sex), as well as the clinico-biological data. The working of the responses was done on SPSS 19 .0. In our study, the diagnosis is carried before an hyperlymphocytosis > 5000/ mm3, a cytological examination of the blood smear and an immunophenotyping operation by cytometer operation in flow. Results: 17 hematology departments have participated in this study with 1210 cases listed, of which 68,1% (824 pts) are men. The average annual recruitment is of 242 cases. The average annual incidence rate, calculated according to the data of the national statistics office is estimated at 0,66 / 100.000 inhabitants.This incidence does not increase over the years and stays relatively stable (2009 = 0,67; 2010 = 0,57; 2011 = 0,63; 2012 = 0,67; 2013 = 0,74/100.000 inhts). The geographic distribution of the pts according to their places of residence, shows that the majority among them are from the north of the country particularly the center (0,80/100.000 inhts). Incidence increases over age, going among men from 0,06 for 100.000 inhts between 30 - 39 years to 11,94 / 100.000 inhts at 80 years and over and among women from 0,04 for 100.000 inhts to 6,08 for 100.000 inhts. The average incidence rate is of 0,85/100.000 inhts among men and of 0,42/100.000 inhts among women. The average age at the diagnosis is of 67,5 years (33 - 98 years). 30,1% (365 pts) incident cases are observed among the patients over 75 years and 14,1% (171 pts) among the patients below the age of 55 years. The profession that is most found is farming 12.2% (78/635 precised). The diagnosis is late in Algeria, the first symptome which brings the patient to consultation is the tumoral syndrome (44% (363 / 825 precised)) in an average diagnosis period of time of 07 months (01 - 96 months). The stage C (classification of Binet) is equally predominant, found in 41,1% (492 / 1172 precised). In terms of biology : the average rate of lymphocytes is of 92500/mm3 (5000-900 000/mm3). The morphological study on blood smear finds 88,2% (1066 / 1208 precised) of typical CLL and 50% of Gambrest cells. The cytometer operation in flow done in 746 cases (61,6%) shows a score of matutes > 4 in 92,3% and in 7,7% is equal to 3. the cytogenetic operation (Caryotype and Fish) done in only one hematology department (CAC of Blida) among 102 patients (8.4%). Comments: The rate of incidence in Algeria is weak compared to that of other countries. The rate of incidence standardized to the world population is of 0,52 cases/100.000 inhts and to the European population is of 0,68 cases p 100.000 inhts. The young age of the population may explain this incidence and that some patients at the stage A are not diagnosed. The CLL affects more frequently men. The average age at the diagnosis is of 67,5 year. However, 30,1% of the incident cases are observed among the patients over 75 years in Algeria versus 45 à 50% of incident cases in Europe and this may be explained by the young age of our population. The CLL are placed 5th among the malignant hemopathies: the rate of incidence for the year 2009 : LNH = 1.96; LH = 1.2; MM = 0.96; AML = 0.85; CLL = 0.67; CML = 0.44; ALL = 0.32. Conclusion: the CLL can be diagnosed and differentiated from the other lymphoproliferative syndromes thanks to the morphological examination of the lymphocytes at the blood smear completed by an immunophenotyping operation of the peripheral blood . This study represents only an epidemiological approach of the CLL in Algeria. The incidence is still weak in our country; it affects as in the other countries the elderly people with a masculin predominance. Disclosures No relevant conflicts of interest to declare.
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