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Hamzy F, Chevallier P, Bruno B, Coiteux V, El Kababri M, Ibrahim A, Oudrhiri A, Yakoub-Agha I, Bekadja MA. [Setting up haploidentical hematopoietic cell transplantation in low- and middle-income countries: The Recommendations of the Francophone Society of Bone Marrow and Cellular Therapy (SFGM-TC)]. Bull Cancer 2025; 112:S146-S156. [PMID: 39426858 DOI: 10.1016/j.bulcan.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/11/2024] [Accepted: 09/13/2024] [Indexed: 10/21/2024]
Abstract
Nowadays, haploidentical hematopoietic cell transplantation (haplo-HCT) has been routinely used worldwide. However, this procedure is still rarely proposed in low- or middle-income countries. During the 13th annual harmonization workshops of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC), a designated working group has proposed recommendations on how to set up such a transplantation in these countries. This was based on a review of the literature and expert-opinion as well as the previously published workshop on haplo-HCT of SFGM-TC (2016). Haploidentical donors appear to be a first alternative to HLA-matched siblings since the access to unrelated donor international registries are limited for several countries. While the procedure has the advantage of immediate access to several potential donors and of low cost, Haplo-HCT should be performed only in centers with a good experience of HLA-matched related transplantation (>10/year). In the absence of an HLA-matched related donor, haplo-HCT should be offered to all patients who are candidate for allo-HCT. Transplantation modalities should follow the conventional procedures with post-transplant cyclophosphamide as GVHD prophylaxis. Conditioning can be myeloablative or not according to each case. Our recommendations are intended to be general in scope and applicable to the majority of allo-HCT centers in these countries. An evaluation at regular basis is needed to assess the feasibility and to improve results.
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Affiliation(s)
- Fati Hamzy
- Service d'hématologie et de greffe de CSH, hôpital Cheikh Zaid, B.P. 6533, avenue Allal El Fassi, Madinat Al Irfane, Hay Riad, Rabat 10000, Maroc.
| | - Patrice Chevallier
- Service d'hématologie clinique, CHU Hôtel-Dieu, place A.-Ricordeau, 44093 Nantes cedex, France
| | - Bénédicte Bruno
- Hématologie pédiatrique, CHU de Lille, 1, place de Verdun, 59037 Lille cedex, France
| | - Valérie Coiteux
- Service de maladies du sang, hôpital Huriez, CHU de Lille, 1, place de Verdun, 59037 Lille cedex, France
| | - Maria El Kababri
- Service d'hématologie et oncologie pédiatrique, hôpital d'enfants de Rabat, université Mohamed V, Rabat, Maroc
| | - Ahmad Ibrahim
- Unités de greffe de moelle, services d'hématologie/oncologie, hôpital Makassed, Middle East Institute of Health, université libanaise, université de Balamand, Beirut, Liban
| | - Anas Oudrhiri
- Service de médecine interne et onco-hématologie, CHU Hassan II Fès, B.P 1835, route Sidi Hrazem, Fès, Maroc
| | - Ibrahim Yakoub-Agha
- Inserm U1286, Infinite, CHU de Lille, université de Lille, 59000 Lille, France
| | - Mohamed-Amine Bekadja
- Service d'hématologie et de thérapie cellulaire, établissement hospitalier universitaire 1er Novembre d'Oran, université Ahmed Benbella 1, Oran, Algérie
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Gómez-De León A, López-Mora YA, García-Zárate V, Varela-Constantino A, Villegas-De Leon SU, González-Leal XJ, del Toro-Mijares R, Rodríguez-Zúñiga AC, Barrios-Ruiz JF, Mingura-Ledezma V, Colunga-Pedraza PR, Cantú-Rodríguez OG, Gutiérrez-Aguirre CH, Tarín-Arzaga L, González-López EE, Gómez-Almaguer D. Impact of payment source, referral site, and place of residence on outcomes after allogeneic transplantation in Mexico. World J Transplant 2024; 14:91052. [PMID: 38947965 PMCID: PMC11212586 DOI: 10.5500/wjt.v14.i2.91052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/29/2024] [Accepted: 03/07/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND The impact of social determinants of health in allogeneic transplant recipients in low- and middle-income countries is poorly described. This observational study analyzes the impact of place of residence, referring institution, and transplant cost coverage (out-of-pocket vs government-funded vs private insurance) on outcomes after allogeneic hematopoietic stem cell transplantation (alloHSCT) in two of Mexico's largest public and private institutions. AIM To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in Mexico. METHODS In this retrospective cohort study, we included adolescents and adults ≥ 16 years who received a matched sibling or haploidentical transplant from 2015-2022. Participants were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in Mexico. Three payment groups were compared: Out-of-pocket (OOP), private insurance, and a federal Universal healthcare program "Seguro Popular". Outcomes were compared between referred and institution-diagnosed patients, and between residents of Nuevo Leon and out-of-state. Primary outcomes included overall survival (OS), categorized by residence, referral, and payment source. Secondary outcomes encompassed early mortality, event-free-survival, graft-versus-host-relapse-free survival, and non-relapse-mortality (NRM). Statistical analyses employed appropriate tests, Kaplan-Meier method, and Cox proportional hazard regression modeling. Statistical software included SPSS and R with tidycmprsk library. RESULTS Our primary outcome was overall survival. We included 287 patients, n = 164 who lived out of state (57.1%), and n = 129 referred from another institution (44.9%). The most frequent payment source was OOP (n = 139, 48.4%), followed by private insurance (n = 75, 26.1%) and universal coverage (n = 73, 25.4%). No differences in OS, event-free-survival, NRM, or graft-versus-host-relapse-free survival were observed for patients diagnosed locally vs in another institution, nor patients who lived in-state vs out-of-state. Patients who covered transplant costs through private insurance had the best outcomes with improved OS (median not reached) and 2-year cumulative incidence of NRM of 14% than patients who covered costs OOP (Median OS and 2-year NRM of 32%) or through a universal healthcare program active during the study period (OS and 2-year NRM of 19%) (P = 0.024 and P = 0.002, respectively). In a multivariate analysis, payment source and disease risk index were the only factors associated with overall survival. CONCLUSION In this Latin-American multicenter study, the site of residence or referral for alloHSCT did not impact outcomes. However, access to healthcare coverage for alloHSCT was associated with improved OS and reduced NRM.
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Affiliation(s)
- Andrés Gómez-De León
- Hematology Service, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey 64460, Nuevo León, Mexico
- Hematology Service, Clínica Gómez Almaguer, Monterrey 64710, Nuevo León, Mexico
| | - Yesica A López-Mora
- Hematology Service, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey 64460, Nuevo León, Mexico
| | - Valeria García-Zárate
- Hematology Service, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey 64460, Nuevo León, Mexico
| | - Ana Varela-Constantino
- Hematology Service, Clínica Gómez Almaguer, Monterrey 64710, Nuevo León, Mexico
- Hematology Service, Instituto Tecnológico de Estudios Superiores de Monterrey, Tec Salud, Escuela de Medicina Ignacio Santos, Monterrey 64710, Nuevo León , Mexico
| | - Sergio U Villegas-De Leon
- Hematology Service, Clínica Gómez Almaguer, Monterrey 64710, Nuevo León, Mexico
- Hematology Service, Instituto Tecnológico de Estudios Superiores de Monterrey, Tec Salud, Escuela de Medicina Ignacio Santos, Monterrey 64710, Nuevo León , Mexico
| | - Xitlaly J González-Leal
- Hematology Service, Clínica Gómez Almaguer, Monterrey 64710, Nuevo León, Mexico
- Hematology Service, Instituto Tecnológico de Estudios Superiores de Monterrey, Tec Salud, Escuela de Medicina Ignacio Santos, Monterrey 64710, Nuevo León , Mexico
| | - Raúl del Toro-Mijares
- Hematology Service, Clínica Gómez Almaguer, Monterrey 64710, Nuevo León, Mexico
- Hematology Service, Instituto Tecnológico de Estudios Superiores de Monterrey, Tec Salud, Escuela de Medicina Ignacio Santos, Monterrey 64710, Nuevo León , Mexico
| | - Anna C Rodríguez-Zúñiga
- Hematology Service, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey 64460, Nuevo León, Mexico
| | - Juan F Barrios-Ruiz
- Hematology Service, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey 64460, Nuevo León, Mexico
| | - Victor Mingura-Ledezma
- Hematology Service, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey 64460, Nuevo León, Mexico
| | - Perla R Colunga-Pedraza
- Hematology Service, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey 64460, Nuevo León, Mexico
| | - Olga G Cantú-Rodríguez
- Hematology Service, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey 64460, Nuevo León, Mexico
| | - César H Gutiérrez-Aguirre
- Hematology Service, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey 64460, Nuevo León, Mexico
| | - Luz Tarín-Arzaga
- Hematology Service, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey 64460, Nuevo León, Mexico
| | - Elías E González-López
- Hematology Service, Clínica Gómez Almaguer, Monterrey 64710, Nuevo León, Mexico
- Hematology Service, Instituto Tecnológico de Estudios Superiores de Monterrey, Tec Salud, Escuela de Medicina Ignacio Santos, Monterrey 64710, Nuevo León , Mexico
| | - David Gómez-Almaguer
- Hematology Service, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey 64460, Nuevo León, Mexico
- Hematology Service, Clínica Gómez Almaguer, Monterrey 64710, Nuevo León, Mexico
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Chen M, Liu Y, Yang X, Hong Y, Ni J. Cost analysis of childhood hematopoietic stem cell transplantation in Sichuan, China. Front Public Health 2023; 11:990181. [PMID: 37033079 PMCID: PMC10076710 DOI: 10.3389/fpubh.2023.990181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Objective To analyze the inpatient cost of hematopoietic stem cell transplantation (HSCT) in children, so as to support clinical decision-making. Methods Study population were children who received HSCT in a tertiary children's hospital (Sichuan, China) between 1st January 2020 and 31st December 2021. The median and interquartile range (IQR) of total cost at 100 days post transplantation were calculated. Subgroup analyses were conducted based on age, gender, transplantation types, and post-transplant complications. The cost differences between subgroups were analyzed to determine whether it had an impact on the total costs. Results A total of 142 pediatric patients were included in the study with a total cost of 250721.78 yuan (197019.16-315740.52, 1 yuan equals to around 0.15 US dollars). Drug costs accounted for 51.85% of the total cost, followed by medical service costs (12.57%) and treatment expenses (12.24%). In terms of transplantation types, the cost of autologous transplantation was lower than that of allogeneic transplantation (115722.98 yuan vs. 256043.99 yuan, p < 0.05), and the cost of human leukocyte antigen (HLA) complete matched was lower compared with that of partial matched (213760.88 yuan vs. 294044.84 yuan, p < 0.05). As for post-transplant complications, cases with <3 types of complications cost less than those with ≥3 types (212893.25 yuan vs. 286064.60 yuan, p < 0.05), and those with severity ≤ grade 2 cost less than those > grade 2 (235569.37 yuan vs. 280061.58 yuan, p < 0.05). Age and gender of patients did not lead to statistical differences in the total cost, while the transplantation types and post-transplant complications influenced the total cost. Conclusion The total cost at 100 days post transplantation associated with HSCT treatment were substantial for pediatric patients. The HLA compatibility between donors and recipients, and post-transplant complications were important factors affecting the total cost.
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Affiliation(s)
- Min Chen
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yantao Liu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xue Yang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Department of Pediatric Hematology and Oncology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yu Hong
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Jiaqi Ni
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
- *Correspondence: Jiaqi Ni,
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Gómez-Almaguer D, Gómez-De León A, Colunga-Pedraza PR, Cantú-Rodríguez OG, Gutierrez-Aguirre CH, Ruíz-Arguelles G. Outpatient allogeneic hematopoietic stem-cell transplantation: a review. Ther Adv Hematol 2022; 13:20406207221080739. [PMID: 35237396 PMCID: PMC8882949 DOI: 10.1177/20406207221080739] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Hematopoietic stem-cell transplantation (HSCT) is usually performed in
well-equipped units inside a hospital. The cost of this in-hospital transplant
is usually very high; therefore, this procedure is more difficult to perform in
low- and middle-income countries. Autologous outpatient HSCT is now a common
procedure; however, outpatient allogeneic transplants are more complicated. Only
a few centers in the world have incorporated outpatient HSCT. This transplant
requires special adaptation, like a day hospital, careful selection of patients,
oral medications, and the patient must live relatively close to the hospital.
The results until now suggest that this outpatient transplant is factible and
similar to inpatient HSCT. The objective was to review and describe the
different methods and results following an outpatient allogeneic-HSCT
strategy.
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Affiliation(s)
- David Gómez-Almaguer
- Hematology Service, Facultad de Medicina y Hospital Universitario ‘Dr. Jose Eleuterio Gonzalez’, Universidad Autónoma de Nuevo León, Francisco I. Madero Ave., Mitras Centro, Monterrey 64460, Nuevo León, México
| | - Andrés Gómez-De León
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Perla R. Colunga-Pedraza
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Olga G. Cantú-Rodríguez
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - César Homero Gutierrez-Aguirre
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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Goel V, Arora P, Malhotra P, Gupta AK. Cost of HSCT in a Tertiary Care Public Sector Hospital in India. Indian J Hematol Blood Transfus 2022; 38:78-83. [PMID: 35125714 PMCID: PMC8804029 DOI: 10.1007/s12288-021-01421-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/24/2021] [Indexed: 01/03/2023] Open
Abstract
India harbours a significant burden of hematological diseases including cancers for which Hematopoietic Cell Transplant (HCT) is a definitive life-saving procedure. Very few studies in India have carried out the costing of the important procedure, hence we undertook a study to ascertain the cost of auto HCT in our tertiary care teaching hospital. We did a prospective study using Top-down and Bottom-up approach to arrive at the cost of autologous HCT which came out to be INR 699,200 ($10,282) out of which hospital bears 34% of the cost. The major share of the hospital cost is on account of expenditure on Human Resources. The rest 66% is Out of Pocket Expenditure (OOPE) for the patients. We also calculated the cost which is borne by patient attendants over & above the cost of procedure while caring for the patient, which on an average came to be INR 88,598. This is approximately 19% of the cost borne by the patient for the procedure itself. The cost is usually not factored in while contemplating the procedure and is not covered by any insurance scheme. The overall cost, OOPE & attendant cost can all lead to a substantial financial hardship. Hence, steps need to be taken to make HCT an affordable and accessible procedure.
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Affiliation(s)
- Vinay Goel
- grid.414546.60000 0004 1759 4765Deputy Medical Superintendent, Civil Hospital, Ambala (Cantt), Haryana India
| | - Pankaj Arora
- grid.415131.30000 0004 1767 2903Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Pankaj Malhotra
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Kumar Gupta
- grid.415131.30000 0004 1767 2903Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Colunga-Pedraza PR, Gómez-De León A, Rodríguez-Roque CS, Morcos-Sandino M, Colunga-Pedraza JE, Cantú-Rodriguez OG, Gutiérrez-Aguirre CH, Gómez-Almaguer D. Outpatient Haploidentical Stem Cell Transplantation Using Post-Transplant Cyclophosphamide Is Safe and Feasible. Transplant Cell Ther 2020; 27:259.e1-259.e6. [PMID: 33781529 DOI: 10.1016/j.jtct.2020.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) feasibility has increased in the last decades because of haplo-HSCT, changes in chemotherapy schedules, and the possibility of an outpatient-based HSCT. The main barriers remain in low-middle income countries. There is a lack of information regarding haplo-HSCT with a myeloablative (MAC) regimen on an outpatient basis. OBJECTIVES Our primary objective was to determine if outpatient haplo-HSCT was feasible. STUDY DESIGN Single center, retrospective cohort, n=60 adult patients undergoing Haplo-HSCT. Descriptive statistical analysis, univariate and multivariate comparison. PATIENTS AND METHOD We analyzed 60 adult patients transplanted with an intended haplo-HSCT on an outpatient basis from 2015 to 2019 in our unit. A multivariate analysis was performed on risk factors for hospitalization. RESULTS Median age was 27 years (15-64). All patients underwent conditioning as outpatients, and none required hospitalization before day 0. Thirteen patients (21.6%) were followed completely in the outpatient clinic and 47 (78.3%) required hospitalization in a median of 3 days after infusion (range, 1-14). The median length of stay (LOS) was 8 days (IQR, 3-17). Fever secondary to cytokine release syndrome (CRS) was the most common reason for hospitalization occurring in 43/47 (91.5%), 4 were related to infection and 36 were related to CRS. In the univariate analysis, CRS, slower engraftment, and female sex were associated with the need for hospitalization. In the multivariate analysis, only CRS remained significant (OR 9.14 [95%CI, 1.58-56.46]). The 2-year overall survival (OS) was 41.7% for ambulatory transplant vs. 38% for those requiring hospitalization (P = 0.12). The 2-year event-free survival (EFS) was 33% for outpatient patients and 16.7% for those hospitalized (log-rank, P = 0.062). CONCLUSIONS We demonstrated the feasibility and safety of carrying out an outpatient haplo-HSCT, potentially resulting in cost savings and perhaps a higher quality of life.
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Affiliation(s)
- Perla R Colunga-Pedraza
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José E. González, Department of Hematology, Internal Medicine Division, Monterrey, Nuevo León, Mexico
| | - Andrés Gómez-De León
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José E. González, Department of Hematology, Internal Medicine Division, Monterrey, Nuevo León, Mexico
| | - Carlos Saúl Rodríguez-Roque
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José E. González, Department of Hematology, Internal Medicine Division, Monterrey, Nuevo León, Mexico
| | - Michelle Morcos-Sandino
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José E. González, Department of Hematology, Internal Medicine Division, Monterrey, Nuevo León, Mexico
| | - Julia E Colunga-Pedraza
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José E. González, Department of Hematology, Internal Medicine Division, Monterrey, Nuevo León, Mexico
| | - Olga Graciela Cantú-Rodriguez
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José E. González, Department of Hematology, Internal Medicine Division, Monterrey, Nuevo León, Mexico
| | - César Homero Gutiérrez-Aguirre
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José E. González, Department of Hematology, Internal Medicine Division, Monterrey, Nuevo León, Mexico
| | - David Gómez-Almaguer
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José E. González, Department of Hematology, Internal Medicine Division, Monterrey, Nuevo León, Mexico.
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Rivera-Franco MM, Leon-Rodriguez E. Overcoming barriers for the establishment of a consolidated hematopoietic cell transplantation program in a developing country. Int J Hematol 2020; 112:707-713. [PMID: 32740763 DOI: 10.1007/s12185-020-02956-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/24/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022]
Abstract
The first hematopoietic cell transplantation (HCT) in Mexico was performed at our institution; however, outcomes were suboptimal the following years, until 1998, when a consolidated HCT was established. The aim of this study was to describe the barriers and the implemented strategies to establish a successful HCT program at a referral center in Mexico and to analyze the outcomes. Barriers were detected based on the results from 1980 to 1997. For the analysis of outcomes, a retrospective study was performed including consecutive patients undergoing autologous, allogeneic, and haploidentical HCT. From November 1998 to December 2018, 363 HCTs were performed (autologous, 59%) in 323 patients. Overall non-relapse mortality (NRM) in autologous and allogeneic HCT was 2% and 14%, respectively. The 5-year overall survival was 71% and 57% for autologous and allogeneic HCT, respectively. The cost of the medications was one of the main limitations for the patients and was successfully overcome by the creation of the non-governmental organization "Unidos". NRM was diminished after reducing the BuCy2 regimen along with the use of bone marrow. Our results highlight that the implementation of unique strategies at our center, led HCT to represent a financially viable and feasible procedure with optimal results.
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Affiliation(s)
- Monica M Rivera-Franco
- Hematopoietic Stem Cell Transplantation Program, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas Y Nutricion Salvador Zubiran, Vasco de Quiroga 15, Belisario Dominguez Seccion XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Eucario Leon-Rodriguez
- Hematopoietic Stem Cell Transplantation Program, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas Y Nutricion Salvador Zubiran, Vasco de Quiroga 15, Belisario Dominguez Seccion XVI, Tlalpan, 14080, Mexico City, Mexico.
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Prognostic value of sarcopenia in survivors of hematological malignances undergoing a hematopoietic stem cell transplantation: a systematic review and meta-analysis. Support Care Cancer 2020; 28:3533-3542. [PMID: 32090284 DOI: 10.1007/s00520-020-05359-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/12/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Sarcopenia is increasingly recognized as an independent risk factor for poor outcomes in patients undergoing hematopoietic stem cell transplantation (HSCT), and it is a potentially modifiable factor. The purpose of the present systematic review and meta-analysis is to summarize and integrate current evidence in this field. METHODS We searched EMBASE, MEDLINE, and Cochrane DSR through Ovid and PubMed websites to identify relevant studies. Studies evaluated sarcopenia before HSCT and reported associations between sarcopenia and post-transplant outcomes were included. Two authors independently applied eligibility criteria, assessed quality, and extracted data. Odds ratio (OR) and their 95% confidence intervals (CIs) were pooled to examine the association between sarcopenia and post-transplant outcomes by using the review manager 5.3 software. RESULTS Seven retrospective cohort studies met our inclusion criteria. The overall quality of studies was low to moderate. Sarcopenia was associated with higher non-relapse mortality [odds ratio (OR) 1.97; 95% CI 1.45, 2.68; P < 0.0001; I2 = 0%] and shorter overall survival [odds ratio (OR) 0.44; 95% CI 0.26, 0.75; P = 0.002; I2 = 65%] in patients undergoing HSCT. CONCLUSIONS Clinicians could use sarcopenia to balance the risks and benefits of transplantation as early as possible; in addition, interventions can be used to prevent sarcopenia and improve physical function and quality of life. Well-designed, prospective, and large-scale clinical studies are needed to consolidate the evidence.
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Leon Rodriguez E, Rivera Franco MM, Ruiz González MC. Association of Outcomes and Socioeconomic Status in Mexican Patients Undergoing Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:2098-2102. [DOI: 10.1016/j.bbmt.2019.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/20/2019] [Accepted: 06/09/2019] [Indexed: 12/14/2022]
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Utility of allogeneic hematopoietic stem cell transplantation using international donors in a homogenous ethnic population: question in the era of various alternative donors. Ann Hematol 2018; 98:501-510. [PMID: 30456421 DOI: 10.1007/s00277-018-3550-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Abstract
The advent of various alternative donors in allogeneic hematopoietic stem cell transplantation (HSCT) raises the question of using international donors, especially in ethnically homogenous populations. We analyzed the clinical outcome and medical expense of human leukocyte antigen (HLA)-matched HSCT using domestic and international donors. We analyzed the patients who received allogeneic HSCT at five medical centers in Korea in the last 10 years. Using propensity-score matching, we compared overall survival (OS), relapse-free survival (RFS), and transplantation-related complications. Medical expense was analyzed based on National Health Insurance Service (NHIS) data. A total of 269 patients were analyzed after 3:1 (domestic/international) matching. There was no difference in OS (p = 0.395) and RFS (p = 0.604) between the domestic and international donor groups (5-year OS rate 42.9 and 37.8%, 5-year RFS rate 37.6 and 33.5% for domestic and international groups, respectively). No difference in chronic graft-versus-host disease (GVHD) incidence was observed (34.2% in domestic and 35.9% in international group, p = 0.804). Early infection was more frequent in the domestic group (55.0 vs. 35.8%, p = 0.007), whereas infection after 30 days was more frequent in the international group (28.7 vs. 49.3%, p = 0.001). Mean medical expense was far higher in the international group, by US $51,944 in the entire follow-up period (p < 0.001). We would expect similar outcomes for international and domestic donors in terms of survival and treatment-related complications with HLA-matched HSCT in other ethnically homogenous populations. These findings should be considered together with the high cost of using international donors in the era of various alternative donors.
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Leon-Rodriguez E, Rivera-Franco MM, Lacayo-Leñero D, Campos-Castro A, Meneses-Medina MI. First - line, non - cryopreserved autologous stem cell transplant for poor - risk germ - cell tumors: Experience in a developing country. Int Braz J Urol 2018; 45:74-82. [PMID: 30325602 PMCID: PMC6442144 DOI: 10.1590/s1677-5538.ibju.2017.0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 07/22/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The current first - line treatment for non - seminomatous germ cell tumor (NSGCT) consists of four cycles of cisplatin, etoposide, and bleomycin (BEP), which results in 5 - year overall survival < 60% in patients with poor - risk features. Autologous hematopoietic stem cell transplantation (auto - HSCT) as a method for overcoming high toxicity after high dose chemotherapy (HDC) has been explored in different solid tumors, but has remained standard practice only for NSGCT. Our objective was to describe outcomes of patients with poor - risk NSGCT who underwent first - line autologous HSCT in a tertiary center in Mexico. PATIENTS AND METHODS Twenty nine consecutive patients with NSGCT who received first - line, non - cryopreserved autologous HSCT at the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City, Mexico, from November 1998 to June 2016, were retrospectively analyzed. RESULTS The median age at transplantation was 23 (15 - 39) years. Most patients (n = 18, 62%) had testicular primary tumor, and 23 had metastases (79%). Complete response after auto - HSCT was observed in 45%. Non - relapse mortality was 0. Five - year relapse / progression free and overall survival were 67% and 69%, respectively. CONCLUSIONS This small single limited - resource institution study demonstrated that patients with poor - risk NSGCT are curable by first - line HDC plus autologous HSCT and that this procedure is feasible and affordable to perform using non - cryopreserved hematopoietic stem cells.
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Affiliation(s)
- Eucario Leon-Rodriguez
- Stem Cell Transplantation Program, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Monica M Rivera-Franco
- Stem Cell Transplantation Program, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Dennis Lacayo-Leñero
- Stem Cell Transplantation Program,Hematology Section, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Andrea Campos-Castro
- Stem Cell Transplantation Program,Hematology Section, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Monica I Meneses-Medina
- Stem Cell Transplantation Program, Oncology Section, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran Mexico City, Mexico
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Rivera Franco MM, Leon Rodriguez E. Importance of Nongovernmental Organizations for the Establishment of a Successful Hematopoietic Stem-Cell Transplantation Program in a Developing Country. J Glob Oncol 2018; 4:1-8. [PMID: 30241235 PMCID: PMC6223420 DOI: 10.1200/jgo.17.00091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose In low- and middle-income countries with limited resources, the success of a hematopoietic stem-cell transplantation (HSCT) program relies directly on its affordability while obtaining similar outcomes to developed regions. The objective of this study was to describe the experience of a tertiary/referral center in Mexico City performing HSCT with the subsidy of a nongovernmental organization (NGO). Patients and Methods We performed a retrospective analysis including 146 patients who underwent HSCT at the National Institutes of Health Sciences and Nutrition Salvador Zubiran and were subsidized by the NGO Unidos. Results Seventy-five patients (51%) and 71 patients (49%) underwent autologous and allogeneic HSCT, respectively. The median age was 30 years, 56% did not obtain a bachelor’s degree, 79% had a low socioeconomic level, and 75% were unemployed. None had any health coverage. According to the real patient out-of-pocket expense, the subsidy by Unidos corresponded to 88% and 72% in autologous and allogeneic HSCT, respectively. Conclusion Our results highlight that undergoing an HSCT was feasible for vulnerable patients because of the subsidy of medications and chemotherapy by Unidos. Therefore, creating NGOs in developing countries is important to provide complex medical procedures, such as HSCT, at limited-resource centers to underserved populations while obtaining good outcomes.
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Affiliation(s)
- Monica M Rivera Franco
- All authors: Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Eucario Leon Rodriguez
- All authors: Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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Leon Rodriguez E, Rivera Franco MM. Outcomes of Hematopoietic Stem Cell Transplantation at a Limited-Resource Center in Mexico Are Comparable to Those in Developed Countries. Biol Blood Marrow Transplant 2017; 23:1998-2003. [PMID: 28733265 DOI: 10.1016/j.bbmt.2017.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 07/11/2017] [Indexed: 01/30/2023]
Abstract
The first hematopoietic stem cell transplantation (HSCT) in Mexico was performed at our institution in 1980. Eighteen years later, our HSCT program was restructured to reduce transplantation-related mortality (TRM) and improve overall survival (OS). The aim of this study was to describe outcomes of HSCT at our institution despite limited resources. Consecutive patients undergoing HSCT, from November 1998 to February 2017, were retrospectively analyzed at the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City. Three hundred nine HSCT (59% autologous) were performed in 275 patients. From 114 patients (41%) undergoing an allogeneic HSCT, acute and chronic graft-versus-host disease developed in 21% and 33%, respectively. From the entire cohort, 98 patients relapsed after HSCT and at the last follow-up, 183 (67%) patients were alive. The 100-day TRM rates were 1.9% and 6.1% for autologous and allogeneic HSCT, respectively. Ten-year relapse/progression-free survival were 54% and 65%, for autologous and allogeneic HSCT, respectively. Ten-year OS rates in autologous and allogeneic HSCT were 61% and 57%, respectively. We highlight that HSCT is feasible in developing countries, despite financial and infrastructure limitations, and conclude that our results are comparable to international literature and probably better in terms of TRM and cost-effectiveness.
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Affiliation(s)
- Eucario Leon Rodriguez
- Hematology and Oncology Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
| | - Monica M Rivera Franco
- Hematology and Oncology Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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