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The development of hematopoietic stem cell transplantation (HSCT) programs can face significant challenges in most developing countries because such endeavors must compete with other government health care priorities, including the delivery of basic services. While this is may be a limiting factor, these countries should prioritize development of the needed expertise to offer state of the art treatments including transplantation, by providing financial, technological, legal, ethical and other needed support. This would prove beneficial in providing successful programs customized to the needs of their population, and potentially provide long-term cost-savings by circumventing the need for their citizens to seek care abroad. Costs of establishing HSCT program and the costs of the HSCT procedure itself can be substantial barriers in developing countries. Additionally, socioeconomic factors intrinsic to specific countries can influence access to HSCT, patient eligibility for HSCT and timely utilization of HSCT center capabilities. This report describes recommendations from the Worldwide Network for Blood and Marrow Transplantation (WBMT) for establishing HSCT programs with a specific focus on developing countries, and identifies challenges and opportunities for providing this specialized procedure in the resource constrained setting.

This study compared retrospectively the effectiveness, toxicity and hematopoietic recovery after autologous peripheral blood stem cell transplantation (ASCT) of two consecutive peripheral blood stem cell mobilization regimens in newly diagnosed MM patients. Patients in group 1 (n=178) were treated with 4 g/m2of cyclophosphamide (CY) plus G-CSF (5 μg/kg/day). Patients in group 2 (n=117) with 750 mg/m2of VP16 plus G-CSF (10 μg/kg/day). Optimal mobilization, defined by a target number of 8 × 106CD34+ cells/kg collected, was achieved in 62.4% and 89.7% of patients in groups 1 and 2, respectively (P<10−4). The median number of aphaeresis sessions was reduced from two in group 1 to one in group 2 (P<10−4). Grade4neutropenia, febrile neutropenia and IV antibiotic use were significantly more frequent in group 1 than in group 2 (P<10−4). Red blood cell transfusion requirements were significantly greater in group 1 (P=0.007). The switch to VP16-G-CSF10resulted in a significant reduction of the number of hospitalization days (P<10−4). Neutrophil and platelet recovery after ASCT occurred on days 11 and 12, respectively, in the two groups with no significant differences. VP16+G-CSF10allowed liberation of resources in the clinical and aphaeresis departments and demonstrated a better effectiveness-safety profile than CY+G-CSF5.

To describe the hematopoietic stem cell transplantation (HSCT) activities for children in the Eastern Mediterranean (EM) region, data on transplants performed for children less than 18 years of age between 1984 and 2011 in eight EM countries (Egypt, Iran, Jordan, Lebanon, Oman, Pakistan, Saudi Arabia and Tunisia) were collected. A total of 5187 transplants were performed, of which 4513 (87%) were allogeneic and 674 (13%) were autologous. Overall, the indications for transplantation were malignant diseases in 1736 (38.5%) and non-malignant in 2777 (61.5%) patients. A myeloablative conditioning regimen was used in 88% of the allografts. Bone marrow (BM) was the most frequent source of stem cells (56.2%), although an increasing use of PBSC was observed in the last decade. The stem cell source of autologous HSCT has shifted over time from BM to PBSC, and 80.9% of autologous HSCTs were from PBSCs. The donors for allogeneic transplants were matched-related in 94.5% of the cases, and unrelated transplants, mainly cord blood (99%) in 239 (5.5%) cases. This is the first report to describe the pediatric HSCT activities in EM countries. Non-malignant disorders are the main indication for allogeneic transplantation. Frequency of alternate donor transplantation is low.

Background: HL, independently of socio economic conditions, is often intrinsically more aggressive in developing countries, including in Tunisia (Tunis Med.1999 77:614). We evaluated clinical characteristics and outcome of HL pts included in a prospective multicenter Tunisian adult HL trial.

Background: HL, independently of socio economic conditions, is often intrinsically more aggressive in developing countries, including in Tunisia (Tunis Med.1999 77:614). We evaluated clinical characteristics and outcome of HL pts included in a prospective multicenter Tunisian adult HL trial. Methods: Between 2002 and 2006, 251 consecutive eligible pts from 6 Tunisian departments with newly diagnosed HL were enrolled in a prospective trial (MDH 2002). Pts were staged using EORTC prognostic factors in early stages and the international prognostic scoring (IPS) in advanced stages. ABVD was used at 3 cycles for favorable (fav) early stages (G1), 6 cycles for unfavorable (unfav) early stages (G2) and stage IIIA (G3) and 8 cycles for fav advanced stages (IPS <3) (G5). Involved field RT was combined to chemotherapy (CT) for early stage and stage IIIA. Intensive CT (4 escalated BEACOPP + 4 standard BEACOPP) was used for unfav advanced stages (IPS 3 3): (G4). G-CSF was given after each escalated BEACOPP course Refractory and relapsed pts were proposed for intensive CT and autologous SCT. Closing date of the study was Dec 2007 Results: Median age at presentation was 31 years (range 15–70), with 140 M and 111 F. 50% patients had advanced disease (28% with stage IV) and 44% had unfav early stage (G2). 25% pts had Bulky mediastinal disease and 69% had B symptoms. 40% pts were treated in G2, 29% in G4, 17% in G5 and only 9% in G1. Eleven (4.3%) toxic deaths were observed during treatment, including 10 deaths in the 72 pts treated with escalated BEACOPP. Of the remaining pts, 83% had CR and 17% had primary failure at the end of the planned treatment (including 14 % with response <50% and 3 % with response between 50 and 75 %. Only 17 (42%) of the primary failure pts could receive auto SCT (13 pts alive in CR, 2 progressive disease and 2 relapses). The 23 remaining refractory pts had progressive disease and died before SCT (16 pts) or failed to respond to salvage CT before SCT (7pts). Twenty five relapses (12%) were observed with a median time to relapse of 9 months: 9(10%) in G2, 6(8%) in G4 and 10(23%) in G5. Five year OS, EFS, and RFS were respectively 88%, 73% and 88%. In multivariate analysis, the only unfavorable prognostic factors emerging were bulky mediastinal disease for primary failure rate (35% vs 10% p=0.0004, OR=5.3) and for EFS (55% vs 80% p = 0.03, OR = 1.9)and remission status at the end of therapy which influenced EFS (87% vs50% vs5% p=0.0000, OR=21.8) and OS (96% vs62%vs 55% p=0.001, OR=14.6) in pts who achieved CR, had primary failure with >50 % to 75% response and with <50% response, respectively Conclusions: This study confirms the high incidence of aggressive forms of HD in Tunisia, therefore frequently requiring intensive treatment, sometimes difficult to apply in pts with relatively low socio economic condition Apart from escalated BEACOPP (which resulted in high toxicity that will have in the future to be better prevented), treatments could however generally be administered completely, which possibly contributed to the relatively few relapses. Bulky mediastinal disease and absence of CR at the end of treatment were, as in other countries, major issues requiring treatment intensification