Worldwide Network for Blood and Marrow Transplantation (WBMT) recommendations for establishing a hematopoietic cell transplantation program (Part I)

Abstract

Hematopoietic cell transplantation (HCT) is a highly complex procedure that requires a dedicated multidisciplinary team to optimize its safety. In addition, institutions may have different needs regarding indications based on regional disease prevalence or may have an interest in developing specialized services. Yet, structured recommendations are not commonly available. Here, the Transplant Center and Recipient Issues Standing Committee for the Worldwide Network for Blood and Marrow Transplantation (WBMT) organized a structured review of all pertinent elements to establish a transplant program. First, we solicited components from committee members and grouped them in domains (infrastructure, staff, cell processing laboratory, blood banking, laboratory, radiology, pharmacy, HLA testing, ancillary services and quality). Subsequently, reviewers scored all elements on a 7-point scale, from an absolute requirement (score of 1) to not required (score of 7). An independent group of five experienced transplant physicians reviewed the rankings. Minimum requirements to establish any HCT program were identified among elements with mean score of ≤2.0, and specific elements for allogeneic and autologous HCT were identified. Mean scores >2.0–4.0 were classified as preferred recommendation, and mean scores of >4.0 to ≤7.0were considered ideal recommendations for advanced and complex types of transplantation. This structured set of recommendations guides the prioritization of minimum requirements to establish a transplant program and to set the path for expansion and further development.

Haematopoietic stem cell transplantation in Tanzania

“…This has led to initiatives by governments, charities and regulatory bodies such as the World Health Organization and Joint Accreditation Committee of the International Society for Cellular Therapy (JACIE) to try to reduce the disparity. 20,21 The Worldwide Network for Blood and Marrow Transplantation (WBMT) recently published recommendations on the establishment of a new transplantation programme. 20,22 In central and southern Africa HSCT is available in only two countries, South Africa and Nigeria, for a population of 1 billion Africans.…”

“…20,21 The Worldwide Network for Blood and Marrow Transplantation (WBMT) recently published recommendations on the establishment of a new transplantation programme. 20,22 In central and southern Africa HSCT is available in only two countries, South Africa and Nigeria, for a population of 1 billion Africans. South Africa has an established transplant programme and performs around 250 autologous transplants and 175 allogeneic transplants per year.…”

“…Once these are fulfilled, the next requirement centres on personnel training, hospital infrastructure, diagnostic and laboratory services, pharmacy and vaccination services, stem cell processing and securing a source of blood products and stem cells. 20,22 These aspects are illustrated in Figure 1.…”

“…The establishment of a pharmacy capable of supplying and monitoring these drugs is a minimum requirement for establishing the transplant centre. 20 Supply from the private sector and donations remain the main sources of drugs for chemo. 30 Diagnostic services.…”

“…30 In addition to laboratory-based diagnostics, availability of radiology services in the transplantation centre (X-ray and computed tomography) is also an essential component of the program. 20 Infrastructure. Haematopoietic stem cell transplantations in HIC have been conducted in isolation rooms with high efficiency particulate air (HEPA) filters, but HEPA filters are not mandatory for HSCT.…”