Stem Cell Transplantation Procedures Are Becoming Affordable for Individuals Living in Developing (Middle-Income) Countries

Ruíz‐Argüelles, Guillermo J.

doi:10.1159/000439107

Cited by 6 publications

(3 citation statements)

References 11 publications

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“…In this instance storage at 4°C might be appropriate for the 1st transplant whereas cells for later transplants could be frozen. (10)(11)(12) 15 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) This study 4º C 143 12 (9-10) 17 In conclusion, storing haematopoietic cells at 4°C could expand autotransplants to centres where more complex technical skills and equipment are lacking and/or where cost may be an issue. It could also reduce complexity and cost at centres presently freezing cells for an autotransplant.…”

Section: Discussionmentioning

confidence: 90%

“…We now report a multicentre, international experience using this method. [10,11] * Presented, in part, at the 56th Annual meeting of the American Society of Haematology, December 4-92014, San Francisco CA. Karduss-Urueta A, Ruiz-Arguelles GJ, Perez R et al Cell-freezing devices are not strictly needed to start an autologous hematopoietic transplantation program: non-cryopreserved peripheral blood stem cells can be used to restore hematopoiesis after high dose chemotherapy: a multicenter experience in 268 autografts in patients with multiple myeloma or lymphoma.…”

Section: Introductionmentioning

confidence: 99%

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Freezing the graft is not necessary for autotransplants for plasma cell myeloma and lymphomas

Kardduss-Urueta

Gale

Gutiérrez-Aguirre³

et al. 2018

Bone Marrow Transplant

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We studied rates of granulocyte and platelets recovery in 359 consecutive subjects receiving blood cell infusions in the context of autotransplants for plasma cell myeloma (N = 216) and lymphomas (N = 143). Blood cells were mobilised with filgrastim given for 4-5 days and collected after a median of 2 (range, 1-2) apheresis. Apheresis products were stored at 4° C for a median of 3 days (range, 2-6 days). Most subjects received carmustine, etoposide, cytarabine and melphalan (BEAM), cyclophosphamide, carmustine and etoposide (CBV) or high-dose melphalan. Filgrastim was given post transplant to 319 subjects. Median numbers of mononuclear cells collected was 31 × 10E + 6/kg (interquartile range (IQR) 37 × 10E + 6 cells/kg). Median numbers of CD34-positive cells collected was 3.6 × 10E + 6/kg (IQR 3.8 × 10E + 6/Kg). Median viability after collection was 90% (IQR 7%) after storage, 88% (IQR 12%). A total of 255 of 256 evaluable subjects recovered bone marrow function and there was no late bone marrow failure. Median interval to neutrophils >0.5 × E + 9/L was 13 days (range, 9-39 days) and to platelets >20 × 10E + 9/L, 16 days (range, 7-83 days). These rates and ranges seem comparable to those reported after autotransplants of frozen blood cells. There was no correlation between numbers of storage days at 4 °C and viability afte storage (r = -0.018, p = 0.14)) nor rates of recovery of neutrophils (r = -0.054, p = 0.52) or platelets (r = 0.116, p = 0.14). Blood cells collected for autotransplant can be stored at 4 °C for 6 d. This method is simple, inexpensive and widely applicable.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Freezing the graft is not necessary for autotransplants for plasma cell myeloma and lymphomas

Kardduss-Urueta

Gale

Gutiérrez-Aguirre³

et al. 2018

Bone Marrow Transplant

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“…As most current protocols for infants with embryonal CNS tumors use HDCT followed by ASCT, this may be challenging in the LMIC setting. Many of these countries lack stem cell transplantation (SCT) facilities, and when available, the cost of this treatment modality requires careful selection criteria . The main challenge in this context is to appropriately allocate resources, considering competing needs for the management of other malignant and nonmalignant conditions .…”

Section: Introductionmentioning

confidence: 99%

Feasibility of high‐dose chemotherapy protocols to treat infants with malignant central nervous system tumors: Experience from a middle‐income country

Elshahoubi

Khattab

Halalsheh

et al. 2018

Pediatric Blood & Cancer

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Background: Results of high-dose chemotherapy (HDCT) protocols for the management of malignant central nervous system (CNS) tumors in infants are mostly reported in high-income countries.We evaluated the feasibility and results of such protocols in a middle-income country (Jordan). Methods:A retrospective study of infants' charts with CNS tumors between 2006 and 2015 who were treated according to HeadStart (HS) protocols. Data included patients' demographics, chemotherapy complications, and cost. Results:We identified 18 patients with median age 29 months (range, 9-62 months) at diagnosis (12 HS-I and six HS-II). Distribution according to pathology was: atypical teratoid rhabdoid tumors (ATRT) (nine), primitive neuoroectodermal tumors (PNET)/pineoblastoma (five), and medulloblastoma (four). Six patients (33%) had metastatic disease, and 14 (78%) had an incomplete resection. Eleven patients achieved partial or complete remission, two stabilized, and five progressed.Ten patients did not proceed to HDCT due to progression (five), financial reasons (two), failure to collect stem cells (one), and undocumented reasons (two). Seventy-eight chemotherapy cycles were administered (median interval 26 days). Main complications during induction and consolidation were febrile neutropenia (73% and 100%), documented infections (8% and 13%), and mucositis (12% and 88%), respectively. Three patients developed moderate hearing loss. No protocol-related mortality was reported. At the last follow-up, five patients were alive: three with medulloblastoma (19, 29, and 89 months) and two with ATRT (18 and 42 months). Three survivors received focal/craniospinal radiation. The median cost of a complete HS protocol, excluding surgery/radiotherapy, was $103 500 per patient; 39% of the median cost was related to pharmacy expenses. Conclusions:These protocols were manageable in our context of limited health care resources.However, considering the significant costs and the modest survival rate, better selection criteria need to be used to identify patients likely to benefit from this approach. K E Y W O R D Sfeasibility, HeadStart protocols, low middle income country, value from KHCC for their great help in estimating the cost of the treatments given. CONFLICTS OF INTERESTThe authors declare that there is no conflict of interest. ORCID Alya Elshahoubi

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Costs of hematopoietic stem cell transplantation in a developing country

Rivera-Franco

Castro-Saldaña

2017

Int J Hematol

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Costs of HSCT in the United States have been widely reported, but complete information on costs in developing countries is lacking. We performed an analysis designed to assess the real, detailed costs of HSCT in Mexico. Using the database of the Current Accounts Department at our Institution, we performed a micro-costing based analysis of patients from 2010 through 2015 to obtain the overall cost of HSCT during the in-patient procedure and 2-month follow-up. One hundred five transplantations (57% autologous) were performed. The most frequent indications for transplantation were lymphomas (32%), followed by acute leukemias (22%). The most frequently used conditioning regimen was reduced BUCY 2 (38%), followed by BEAM (28%). Among post-transplant complications, acute graft-versus-host-disease was not associated with higher costs (p = 0.8). The median costs (in-patient and 2-month outpatient follow-up) for auto and allo-HSCT were 12,155 and 18,260 USD, respectively. Advances in HSCT technology have improved outcomes and increased the availability of this technique; however, this procedure can also significantly influence the socioeconomic wellbeing of patients, especially in developing countries. Our study highlights the feasibility of performing HSCT in Mexico at lower costs than developed countries, while preserving quality of care.

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Stem Cell Transplantation Procedures Are Becoming Affordable for Individuals Living in Developing (Middle-Income) Countries

Cited by 6 publications

References 11 publications

Freezing the graft is not necessary for autotransplants for plasma cell myeloma and lymphomas

Freezing the graft is not necessary for autotransplants for plasma cell myeloma and lymphomas

Feasibility of high‐dose chemotherapy protocols to treat infants with malignant central nervous system tumors: Experience from a middle‐income country

Costs of hematopoietic stem cell transplantation in a developing country

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