Implementation of Haploidentical Stem Cell Transplantation for Adult Patients in Cuba

The Hermanos Ameijeiras Hospital (HAH) (Havana) is the primary center performing allogeneic hematopoietic stem cell transplantation (HSCT) in adult patients in Cuba, but has no access to donor registries because of the economic embargo. To implement HSCT from haploidentical donors in Cuba, in 2016 HAH and University of Illinois at Chicago (UIC) started a collaboration that included: training one Cuban transplant physician at UIC for 3 months, exchange of guidelines and protocols, continued open access to UIC consultants, and two educational programs in Cuba. HAH performed 2 haplotransplants in 2016, 3 in 2017 and 5 until August 2018 in total 9 adult patients (median age 32 years, range: 21-54). Diagnoses included: AML (n=5), biphenotypic leukemia (n=2), T-ALL (n=1), plasmacytoid dendritic cells neoplasia (n=1). At the time of transplant, 4 patients had active disease. Donors were: mother (n=8), father (n=1) or child (1). All patients received fresh stem cells from mobilized peripheral blood (n=8) or bone marrow (n=2). Median cell dose infused was 5.3 × 108 total nucleated cells/kg (range: 3-8) (flow cytometry not available). Conditioning regimens utilized were myeloablative in 6, and reduced intensity in 4 transplants, and GVHD prophylaxis was standard PT-Cy, CsA and mycophenolate. Median time to neutrophil and platelet engraftment was 17 days (range:12-18) and 15 days (range:11-26), respectively. Acute graft-versus-host disease (GVHD) grade 2-4 occurred in 3 patients and chronic GVHD in 1. Day 100 overall survival was 80% and at a median follow-up of 223 days (range: 12-832) 6 patients (70%) are alive, 4 (44%) in CR and 2 in relapse. Three patients died due to relapse, brain hemorrhage and acute GVHD, respectively. Despite the limited technological resources not allowing regular monitoring of CD34+ cell counts, chimerism or CMV, haploidentical HSCT has been implemented in Cuba and represents a cost-effective and impactful innovative therapy for this low-middle-income country. The collaboration between HAH and UIC has been instrumental in building clinical and research capacity in Cuba.