Setting up and sustaining blood and marrow transplant services for children in middle-income economies: an experience-driven position paper on behalf of the EBMT PDWP.
Lawrence FaulknerMarta VernaAttilio RovelliRajat Kumar AgarwalRakesh DhanyaLalith ParmarAmit SedaiAnkita KumariStalin RamprakashC P RaghuramPallavi MehtaSandeep ElizabethSadaf KhalidAliya BatoolSarah Khan GhilaniItrat FatimaTatheer ZaraPriya MarwahRajpreet SoniDeepa TrivediValentino ConterMarta CanesiDosti OthmanVian FaeqKatharina KleinschmidtAkif YesillipekCatherine G LamScott C HowardSelim Corbacioglunull nullPublished in: Bone marrow transplantation (2020)
Severe blood disorders and cancer are the leading cause of death and disability from noncommunicable diseases in the global pediatric population and a major financial burden. The most frequent of these conditions, namely sickle cell disease and severe thalassemia, are highly curable by blood or bone marrow transplantation (BMT) which can restore a normal health-related quality of life and be cost-effective. This position paper summarizes critical issues in extending global access to BMT based on ground experience in the start-up of several BMT units in middle-income countries (MICs) across South-East Asia and the Middle East where close to 700 allogeneic BMTs have been performed over a 10-year period. Basic requirements in terms of support systems, equipment, and consumables are summarized keeping in mind WHO's model essential lists and recommendations. BMT unit setup and maintenance costs are summarized as well as those per transplant. Low-risk BMT is feasible and safe in MICs with outcomes comparable to high-income countries but at a fraction of the cost. This report might be of assistance to health care institutions in MICs interested in developing hematopoietic stem cell transplantation services and strengthening context appropriate tertiary care and higher medical education.
Keyphrases
- sickle cell disease
- healthcare
- bone marrow
- mental health
- medical education
- tertiary care
- physical activity
- primary care
- early onset
- multiple sclerosis
- stem cell transplantation
- affordable care act
- papillary thyroid
- young adults
- mesenchymal stem cells
- acute myeloid leukemia
- stem cells
- risk factors
- type diabetes
- low dose
- squamous cell
- adipose tissue
- skeletal muscle
- drug induced
- insulin resistance
- weight loss