Current status of hematopoietic stem cell transplantations in Vietnam

Abstract

In Vietnam, the first three cases of Allo-BMT were successfully performed in 1995 at the Blood Transfusion and Hematology Hospital (BT-H) of Ho Chi Minh City. Donors were HLA fully matched siblings (HLA-A, HLA-B and HLA-DRB1). The patients were a 26-year-old man with CML in chronic phase (CP), a 12-year-old woman with b-thalassemia/Hb E and a 9-year-old girl with b-thalassemia/Hb E. All patients were engrafted with the median time to recover ANC40.5 Â 10 9 /l, and platelet count 420 Â 10 9 /l was 16 and 38 days. At 12 years after transplantation, all three patients are alive and well. Today, Vietnam has five SCT centers; in the north, there are three centers: 108 Military Hospital, Pediatric Institute and Blood transfusion and Hematology Institute; in the middle of Vietnam is Hue Hospital and in the south, the BT-H Hospital of Ho Chi Minh City. Until now, 65 patients have had SCT in Vietnam; among them, 52 patients had SCT at the BT-H Hospital, Ho Chi Minh City. Because of no connection of data between different SCT centers, we present here only the results performed at the BT-H Hospital, Ho Chi Minh City. With Allo-SCT we performed 19 cases with 3 procedures: BMT (4 cases), PBSC (6 cases) and cord blood transplantation (9 cases); patients were diagnosed with AML (n ¼ 7), ALL (n ¼ 1), CML (n ¼ 5) and b-thalassemia (n ¼ 6). Following transplantation, 7 patients (36.84%) relapsed, 12 (63.16%) remained alive and overall survival times: 6.81 ± 1.35 years, disease-free survival times: 6.69 ± 1.4 years (range 0.5-12 years). With Auto-SCT: since November 1996, we have performed 33 cases of autologous PBSC transplantation consisting of without cryopreservation (24 cases) and with cryopreservation (9 cases); patients were diagnosed with AML in CR1 (n ¼ 21), ALL in CR1 (n ¼ 6), CML in CP (n ¼ 5) and non-Hodgkin's lymphoma in CR1 (n ¼ 1). The median age of the patients was 35 years (range 18-46). The median time to recover ANC 40.5 Â 10 9 /l and platelet count 420 Â 10 9 /l was 14 days (range 9-25 days) and 35 days (range 9-120 days). Following transplantation, 18 patients (54.50%) relapsed, 15 (45.45%) remained alive and overall survival times: 5.74 ± 0.82 years and disease-free survival times: 5.48 ± 0.92 years. There was no statistically significant difference of overall survival and disease-free survival between Allo-SCT and Auto-SCT procedures (P40.05). These preliminary data suggest that HSCTs have been used as one of the standard treatments for hematological diseases and malignancies in Vietnam and that cord blood is an alternative source of hematopoietic stem cells for allogeneic transplantation in children.

Hematopoietic SCT activity in Asia: a report from the Asia-Pacific Blood and Marrow Transplantation Group

“…Recent reports on HSCT from Asian countries suggest the progress of HSCT in this region. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] However, no comprehensive picture of the current state of HSCT in Asia has been obtained. The Asia-Pacific region consists of countries with various ethnic, economical and social backgrounds.…”

Hematopoietic Stem-Cell Transplantation in the Resource-Limited Setting: Establishing the First Bone Marrow Transplantation Unit in Bangladesh

“…Centers in these countries have performed allogeneic transplantations for a variety of diseases, the majority for which are thalassemias. 13 , 16 , 17 There are clearly unmet medical needs that can be addressed by transplantation, and future partnerships that are led by experienced transplantation centers will be critical for the efficient establishment and expansion of HSCT to the developing world.…”

“…Whereas the initial cost of an allogeneic transplantation is approximately $200,000 in developed countries, 28 similar protocols in a developing country generally cost almost an order of magnitude less, ranging from approximately $10,000 to $25,000. 13 - 17 Even at these lower costs, transplantation remains prohibitively expensive for most of the population in these countries. For example, whereas a recent report suggested that the average upfront allogeneic transplantation in India costs approximately $17,000, only approximately 5% of the population is able to afford a transplantation.…”

“…Nevertheless, interest in developing HSCT programs for resource-limited settings has steadily increased, and several countries have described successful programs for both autologous and allogeneic transplantation ( Table 1 ). 13 - 17 The potential ability for HSCT to cure certain chronic, debilitating diseases, such as transfusion-dependent thalassemia in children, 17 may economically justify its use relative to other treatments available when accounting for long-term costs.…”

Clinical trials and venture tribulations: Stem cell research and the making of Vietnamese bio-entrepreneurs

“…A telling case is the Haematology hospital in Hồ Chí Minh City, which pioneered the first stem cell transplant in the country (1995) using bone marrow cells to treat a blood cancer patient. Since then, it has ‘successfully carry out hundreds of transplants’, according to past and current directors (Van Be et al., 2008: 146). Today, the hospital is poised to launch a commercial stem cell bank alongside its national blood storage services, fostering ambitions to trade in stem cells with foreign partners in Europe and beyond.…”