Hematopoietic stem cell transplantation in Egypt

Mahmoud, Hossam K.; Elhaddad, Alaa; Fahmy, Omar; Elemary, Mohamed; Nassar, A. M.; Abdel-Mooti, Mohamed; Sobhy, Ali; Sultan, Almetwaly M.

doi:10.1038/bmt.2008.136

Cited by 34 publications

(28 citation statements)

References 11 publications

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“…Hence in many developing countries, PBSC is used as the predominant or sole graft source in SAA. 5,6,40,49-51 Survival rates in this high risk population, with PBSC are reported as 75-80%. 40,43,49,51 …”

Section: Discussionmentioning

confidence: 90%

Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions

Kumar

Kimura

Ahn

et al. 2016

Biology of Blood and Marrow Transplantation

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Bone marrow (BM) is the preferred graft source for hematopoietic stem cell transplantation (HSCT) in severe aplastic anemia (SAA) compared to mobilized peripheral blood stem cells (PBSC). We hypothesized that this recommendation may not apply to those regions where patients present later in their disease course, with heavier transfusion load and with higher graft failure rates. Patients with SAA who received HSCT from an HLA-matched sibling donor from 1995 to 2009 and reported to the Center for International Blood and Marrow Transplant Research or the Japan Society for Hematopoietic Cell Transplantation were analyzed. The study population was categorized by gross national income per capita (GNI) and region/countries into four groups. Groups analyzed were high income countries (HIC), which were further divided into US-Canada (N=486) and other HIC (N=1264), upper middle-income (UMIC) (N=482), and combined lower middle, low income countries (LM-LIC) (N=142). In multivariate analysis, overall survival (OS) was highest with BM as graft source in HIC compared to PBSC in all countries or BM in UMIC or LM-LIC (p<0.001). There was no significant difference in OS between BM and PBSC in UMIC (p=0.32) or LM-LIC (p=0.23). In LM-LIC the 28-day neutrophil engraftment was higher with PBSC compared to BM (97% vs. 77%, p<0.001). Chronic GVHD was significantly higher with PBSC in all groups. Whereas BM should definitely be the preferred graft source for HLA-matched sibling HSCT in SAA, PBSC may be an acceptable alternative in countries with limited resources when treating patients at high risk of graft failure and infective complications.

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Section: Discussionmentioning

confidence: 90%

Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions

Kumar

Kimura

Ahn

et al. 2016

Biology of Blood and Marrow Transplantation

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“…BMT represents a viable therapeutic avenue in developed countries in spite of the associated risks, albeit the price of allogenic BMT exceeds $200 000 (in the United States). 159 The extent of infrastructure and resources required for BMT restricts its wide use in developing countries, 160,161 which have the highest prevalence of b-globin disorders. 162 …”

Section: -151mentioning

confidence: 99%

Customizing the genome as therapy for the β-hemoglobinopathies

Canver

Orkin

2016

Blood

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Despite nearly complete understanding of the genetics of the β-hemoglobinopathies for several decades, definitive treatment options have lagged behind. Recent developments in technologies for facile manipulation of the genome (zinc finger nucleases, transcription activator-like effector nucleases, or clustered regularly interspaced short palindromic repeats–based nucleases) raise prospects for their clinical application. The use of genome-editing technologies in autologous CD34+ hematopoietic stem and progenitor cells represents a promising therapeutic avenue for the β-globin disorders. Genetic correction strategies relying on the homology-directed repair pathway may repair genetic defects, whereas genetic disruption strategies relying on the nonhomologous end joining pathway may induce compensatory fetal hemoglobin expression. Harnessing the power of genome editing may usher in a second-generation form of gene therapy for the β-globin disorders.

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“…In Egypt, HSCT was found to cost 15,000 USD all of it is provided by health insurance and Ministry of health. [9] Lack of trained health professionals and limited transplant centers were other reasons for rarity of HSCT in Egypt. Furthermore the relatively effective antithymocyte globulin was not available for our patients with AA as it is too expensive.…”

Section: Discussionmentioning

confidence: 99%

“…[5] A study by Mahmoud et al showed that AA comprised 21% of a total of 1300 patients who received HSCT over 18-years in Egypt. [9] The current research studied current situation and future prospectives of AA, in Egypt. In this study the median age of patients with AA was obviously lower than that in other studies (30-years vs. 53 &40-years), meanwhile it was consistent with other studies.…”

Section: Discussionmentioning

confidence: 99%

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Aplastic Anemia in Egypt: Current Situation and Future Prospective

Khaled¹

2016

AJIM

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Aplastic anemia (AA) is a hypoproliferative anemia that led to a significant morbidity and mortality. Recently, dramatic improvement in prognosis of AA was achieved; this was in part due to advances in immunosuppressive therapy and HSCT. Nevertheless, AA is still one of the most challenging hematological disorders that could face a hematologist. This study was conducted at Assiut University Hospital (AUH), Assiut, Egypt to evaluate current situation and future prospective of AA. 63 patients with AA were prospectively enrolled in the study; they were admitted at the Hematology unit, AUH in the period 1stJan 2011 to Feb 2012, a 38 patients with iron deficiency anemia (IDA) were included for comparison. Patients' demographic and clinical data were collected through medical history and clinical examination. Both direct and indirect health care costs of anemia were assessed Direct parameters included doctors' and hospital fees, costs of laboratory investigations, medication fees and costs of HSCT or any procedure. Indirect costs included travelling expenses and earning losses. Social burden of anemia was estimated by anemia related morbidity and mortality. Data were analyzed with SPSSV.17, results showed that AA affected young age group with mean age 30.89±13.39 years, without sex predilection, acquired AA was more common than idiopathic (55.6% vs. 44.4%), however mortality was higher in idiopathic AA (46.2%). Causes of aplasia were exposure to chemicals, drugs and hepatitis in order. Only 63.5% of AA were admitted once and 47.6% in general ward, the mean hospital days for patients with AA was 17.73±11.10, compared to 8.32±6.69 in IDA, P=0.000, also higher socio-economic burden of AA was found compared with IDA. These results denoted that management of AA is still ineffective, and that there is a definite need for a strict plan to prevent incidence of AA, particularly in developing countries where effective management of AA is too expensive and relatively unavailable.

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Hematopoietic stem cell transplantation in Egypt

Cited by 34 publications

References 11 publications

Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions

Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions

Customizing the genome as therapy for the β-hemoglobinopathies

Aplastic Anemia in Egypt: Current Situation and Future Prospective

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