Making Allogeneic Bone Marrow Transplantation Available to Patients in Developing Countries: The Mexican Experience

摘要

Non-myeloablative allogeneic stem cell transplantation (NST) has been one of the most exciting developmentsin the treatment of hematologic malignancies in the last years. Since 1999, we have chosen to employ in México a regimento conduct NST, introducing some changes with the main goal of decreasing the cost of the procedure and in turn,making it available to a larger number of patients in developing countries. Using this method we have done over 400 allograftsin Latin American patients with different both malignant and non-malignant diseases: Chronic myelogenous leukemia,acute myelogenous leukemia, acute lymphoblastic leukemia, myelodysplasia, thalassemia major, relapsed Hodgkin′s disease, Blackfan-Diamond syndrome, adrenoleukodystrophy, Hunter′s syndrome, aplastic anemia and several solidtumors. In the whole group, the median granulocyte recovery time to 0.5 x 109/L was 13 days, whereas the median plateletrecovery time to 20 x 109/L was 12 days. Around one third of the patients did not need red blood cell transfusions and alsoone third did not need platelet transfusions. In more than 70% of cases the procedure could be completed totally on anoutpatient basis. The follow up time of the patients ranges between 30 and 2000 days. Approximately 50% of the allograftedindividuals have developed acute graft versus host disease (GVHD), whereas around 30% developed chronicGVHD. The median post-allograft overall survival (SV) has not been reached and the 2000 day overall SV is 54%, the100-day mortality being 16%. In the whole group of patients, the median cost of each NST was 18 000 USD, a figurewhich contrasts with that informed from developing countries. More than 95% of the patients who were allografted inMéxico and Latin America using this method could not have afforded the cost of a conventional or more expensive stemcell transplant; accordingly, this procedure has enabled doctors in México and Latin America to offer this therapeutic approachto a larger number of individuals.