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PERIPHERAL BLOOD STEM CELL TRANSPLANT IN DEVELOPING COUNTRIES

PERIPHERAL BLOOD STEM CELL TRANSPLANT IN DEVELOPING COUNTRIES. Salman N. Adil Consultant Hematologist & Transplant Physician THE AGA KHAN UNIVERSITY. STEM CELLS (PLURIPOTENT STEM CELLS) Self-Renewal Differentiation. HISTORY. Administration of BM by mouth nearly a century ago.

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PERIPHERAL BLOOD STEM CELL TRANSPLANT IN DEVELOPING COUNTRIES

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  1. PERIPHERAL BLOOD STEM CELL TRANSPLANT IN DEVELOPING COUNTRIES Salman N. Adil Consultant Hematologist & Transplant Physician THE AGA KHAN UNIVERSITY

  2. STEM CELLS (PLURIPOTENT STEM CELLS) Self-Renewal Differentiation

  3. HISTORY • Administration of BM by mouth nearly a century ago. • Defective marrow restored in mice. • Late 1950 – Transplant following radiation accident in France. • HLA discovery in 1958 by Jean Dausett.

  4. First successful transplantation 1968 – University of Minnesota. Recipient -- child with SCID. 1973 – 1st Matched unrelated transplant in SCID on 5 year old -- donor from Copenhagen.

  5. HLA further refined. • HLA • A • B ------- crucial for successful engraftment. • DR • 1990 Dr.E. Donald Thomas was awarded the Nobel Prize in Medicine for his pioneering work in transplantation.

  6. RATIONALE FOR STEM CELL TRANSPLANTATION High dose chemotherapy Myelosuppression Immunosuppression STEM CELL RESCUE Death Cure

  7. DISEASES SUITABLE FOR TRANSPLANT • Malignant Disorders • Acute and Chronic Leukemias • Lymphomas • Hodgkin’s Disease. • Multiple Myeloma. • Myelodysplastic Syndrome. • Myelofibrosis. • Neuroblastoma • Germ Cell Tumors.

  8. DISEASES SUITABLE FOR TRANSPLANT • Severe Aplastic Anaemia • Thalassemias • Congenital Immunodeficiency Disorders • Fanconi’s Anemia Benign Disorders

  9. ADVANTAGES OF AUTOLOGOUS TRANSPLANT • 1. No rejection • 2. Less immune disruption, toxicity and infection • 3. No GVHD • 4. Transplant related mortality is <2% • 5. Donor availability

  10. ADVANTAGES OF ALLOGENEIC TRANSPLANT 1, GVL (Graft vs. Leukemia effect) GVD (Graft vs. Disease effect) 2.No tumor contamination 3.Lower tumor recurrence (long-term)

  11. CURRENT STATUS OF BMT IN PAKISTAN • 3 Centers currently operational :- 1. BTI --- Karachi 2. AFIBMT --- Rawalpindi 3. AKU ---- Karachi About 275 transplants performed so far.

  12. BMT CENTERS IN REGION • India 15 centers • Oman 1 center • Saudi Arabia 2 centers • Iran 1 center

  13. ECONOMICS OF TRANSPLANT • Population :- 150 Million • Per Capital Income:- 650 Dollars a year. • Health Budget:- Poor • No insurance system • Average cost of transplant in Pakistan Rs. 1.0 – 1.4 million

  14. CHALLENGES IN DEVELOPING COUNTRIES • Literacy rate affecting awareness • Health budget • Health problems • Infectious diseases • Water and nutrition

  15. CHALLENGES IN DEVELOPING COUNTRIES ( contd) • Large-sized families , over crowding • High cost of transplant • High cost of transplant complications

  16. FUTURE DIRECTIONS • More programs needed. • Training of personel • Donor Registry India:- Two registries • Patients awareness • Physician awareness • Early referral • Education about indications of transplant.

  17. Establishment of Cord Blood Banks • Stem Cell Transplantation in Non-Hematological Disorders. • Neurology • Cardiology

  18. Thank You...

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