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Special issues related to hematopoietic SCT in the Eastern Mediterranean region and the first regional activity report

Abstract

Although several centers are now performing allogeneic hematopoietic SCT (HSCT) in the Eastern Mediterranean (EM) region, the availability is still limited. Special issues including compatible donor availability and potential for alternative donor programs are discussed. In comparison to Europe and North America, differences in patterns of diseases and pre-HSCT general status, particularly for patients with BM failure, are described. Other differences including high sero-positivity for CMV, hepatitis B and C infection, and specific observations about GVHD and its relation to genetically homogeneous communities are also discussed. We report that a total of 17 HSCT programs (performing five or more HSCTs annually) exist in 9 countries of the EM region. Only six programs are currently reporting to European Group for Blood and Marrow Transplantation or Center for International Blood and Marrow Transplantation Research. A total of 7617 HSCTs have been performed by these programs including 5701 allogeneic HSCTs. The area has low-HSCT team density (1.56 teams per 10 million inhabitants vs 14.43 in Europe) and very low-HSCT team distribution (0.27 teams per 10 000 sq km area vs <1–6 teams in Europe). Gross national income per capita had no clear association with low-HSCT activity. Much improvement in infrastructure and formation of an EM regional HSCT registry are needed.

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References

  1. Countries in the WHO Eastern Mediterranean Region shown on http://www.who.int/about/regions/emro/en/index.html (last accessed on 12th September 2008).

  2. Shamsi T, Hashmi K, Irfan M, Ahmed P, Farzana T, Satti T et al. The stem cell transplant program in pakistan—the first decade. Bone Marrow Transplant 2008; 42: S114–S117.

    Article  PubMed  Google Scholar 

  3. Othman TB, Torjemane L, Abdelkefi A, Lakhal A, Ladeb S, Hamed LB et al. Allogeneic stem cell transplantation in Tunisia. Bone Marrow Transplant 2008; 42: S139–S141.

    Article  PubMed  Google Scholar 

  4. Mahmoud HK, El-Haddad AM, Fahmy OA, El-Emary M, Nassar A, Abdel-Mooti M et al. Hematopoietic stem cell transplantation in Egypt. Bone Marrow Transplant 2008; 42: S76–S80.

    Article  PubMed  Google Scholar 

  5. Abdel-Rahman F, Hussein AA, Rihani R, Hlalah OA, El Taani H, Sharma S et al. Bone marrow and stem cell transplantation at King Hussein Cancer Center (KHCC) Amman—Jordan. Bone Marrow Transplant 2008; 42: S89–S91.

    Article  PubMed  Google Scholar 

  6. Dennison D, Al Kindi S, Pathare A, Daar S, Nusrat N, Rehman J et al. Hematopoietic stem cell transplantation in Oman. Bone Marrow Transplant 2008; 42: S109–S113.

    Article  PubMed  Google Scholar 

  7. Bazarbachi A, Hatoum HA, Mugharbel A, Otrock ZK, Yassine N, Muwakkit S et al. Hematopoietic stem cell transplantation in Lebanon: first comprehensive report. Bone Marrow Transplant 2008; 42: S96–S102.

    Article  PubMed  Google Scholar 

  8. Benchekroun S, Harif M, Madani A, Quessar A, Zafad S, Rachid R . Present and future of hematology and stem cell transplantation in Morocco. Bone Marrow Transplant 2008; 42: S106–S108.

    Article  PubMed  Google Scholar 

  9. Sheth KV, Elkhalifa M, Kelly T, Sahovic E . What are the chances of finding related HLA match donors for allogeneic BMT recipients in Saudi Arabia? Blood 1996; 88 (Suppl 1): 265b (Abstract 3787).

    Google Scholar 

  10. Gyger M, Sahovic E, Al Mohareb F, Chaudhri N, Al Zahrani H, Al Sharif F et al. A prospective randomized trial of marrow versus mobilized peripheral blood in HLA-matched related allogeneic transplants using a three-day short course methotrexate and cyclosporin as prophylaxis for acute graft versus host disease. Bone Marrow Transplant 2002; 29 (Suppl 2): 677 (abstract 84).

    Google Scholar 

  11. Al Beihany A, Sahovic E, Chaudhri N, Almohareb F, Alsharif F, Alzahrani H et al. Leukemia relapse after allogeneic bone marrow transplantation—how does chronic GVHD influence the pattern and onset of relapse? Bone Marrow Transplant 2005; 35 (Suppl. 2): S135 (Abstract 536).

    Google Scholar 

  12. Stem Cell Trialists' Collaborative Group. Individual patient data met-analysis of allogeneic peripheral blood stem cell transplant vs bone marrow transplant in the management of hematological malignancies: indirect assessment of the effect of day 11 methotrexate administration. Bone Marrow Transplant 2006; 38: 539–546.

    Article  Google Scholar 

  13. Stem Cell Trialists' Collaborative Group. Allogeneic peripheral blood stem-cell compared with bone marrow transplantation in the management of hematologic malignancies: an individual patient care data meta-analysis of nine randomized trials. J Clin Oncol 2005; 23: 5074–5087.

    Article  Google Scholar 

  14. Oh H, Loberiza Jr FR, Zhang MJ, Ringdén O, Akiyama H, Asai T et al. Comparison of graft-versus-host disease and survival after HLA-identical sibling bone marrow transplantation in ethnic population. Blood 2005; 105: 1408–1416.

    Article  CAS  PubMed  Google Scholar 

  15. Bu R, Gutierrez MI, Al-Rasheed M, Belgaumi A, Bhatia K . Variable drug metabolism genes in Arab population. Pharmacogenomics J 2004; 4: 260–266.

    Article  CAS  PubMed  Google Scholar 

  16. Brown KE, Tisdale J, Barrett AJ, Dunbar CE, Young NS . Hepatitis-associated aplastic anemia. N Engl J Med 1997; 336: 1059–1064.

    Article  CAS  PubMed  Google Scholar 

  17. Hibbs JR, Frickhofen N, Rosenfeld SJ, Feinstone SM, Kojima S, Bacigalupo A et al. Aplastic anemia and viral hepatitis non-A, non-B, non-C? JAMA 1992; 267: 2051−–2054.

    Article  PubMed  Google Scholar 

  18. Druker BJ, Talpaz M, Resta DJ, Peng B, Buchdunger E, Ford JM et al. Efficacy and safety of a specific inhibitor of the BCR-ABL tyrosine kinase in chronic myeloid leukemia. N Engl J Med 2001; 344: 1031–1037.

    Article  CAS  PubMed  Google Scholar 

  19. Lee KW, Choi IS, Roh EY, Kim DY, Yun T, Lee DS et al. Adult patients with t(8;21) acute myeloid leukemia had no superior treatment outcome to those without t(8;21): a single institution's experience. Ann Hematol 2004; 83: 218–224.

    Article  CAS  PubMed  Google Scholar 

  20. Marcucci G, Maharry K, Radmacher MD, Mrózek K, Vukosavljevic T, Paschka P et al. Prognostic factors and outcome of core binding factor acute myeloid leukemia patients with t(8;21) differ from those of patients with inv(16): a Cancer and Leukemia Group B study. J Clin Oncol 2005; 23: 5705–5717.

    Article  PubMed  Google Scholar 

  21. Nucifora G, Rowley JD . AMLl and the 8;21 and 3;21 Translocations in Acute and Chronic Myeloid Leukemia. Blood 1995; 86: 1–14.

    CAS  PubMed  Google Scholar 

  22. Muller AMS, Ihorst G, Mertelsmann R, Engelhardt M . Epidemiology of non-Hodgkin's lymphoma (NHL): trends, geographic distribution, and etiology. Ann Hematol 2005; 84: 1–12.

    Article  PubMed  Google Scholar 

  23. Sahovic E, Al-Suliman A, Aslam M, Seth P, Akhtar J, Aljurf M et al. Successful prevention of CMV disease after allogeneic BMT in 100 consecutive CMV seropositive recipients. Blood 1999; 94: 372b (Abstract 4888).

    Google Scholar 

  24. Chandy M, Srivastava A, Dennison D, Mathews V, George B . Allogeneic bone marrow transplantation in the developing world: experience from a center in India. Bone Marrow Transplant 2001; 27: 785–790.

    Article  CAS  PubMed  Google Scholar 

  25. Boeckh M, Bowden RA, Gooley T, Myerson D, Corey L . Successful modification of a pp65 antigenemia-based early treatment strategy for prevention of cytomegalovirus disease in allogeneic marrow transplant recipients. Blood 1999; 93: 1781.

    CAS  PubMed  Google Scholar 

  26. Al-Faleh FZ . Hepatitis B infection in Saudi Arabia. Ann Saudi Med 1988; 8: 474–480.

    Article  Google Scholar 

  27. Arya SC, Ashraf SJ, Parande CM, el-Sayed M, Sahay R, Ageel AR et al. Hepatitis B virus in Gizan. Saudi Arabia. J Med Virol 1985; 17: 267–274.

    Article  CAS  PubMed  Google Scholar 

  28. Andre F . Hepatitis B epidemiology in Asia, the Middle East and Africa. Vaccine 2000; 18 (Suppl 1): S20–S22.

    Article  PubMed  Google Scholar 

  29. Seth P, Alrajhi AA, Kagevi I, Chaudhary MA, Colcol E, Sahovic EA et al. Hepatitis B virus reactivation with clinical flare in allogeneic stem cell transplants with chronic graft-versus-host disease. Bone Marrow Transplant 2002; 30: 189–194.

    Article  CAS  PubMed  Google Scholar 

  30. Theodore SY, Jamal MM . Epidemiology of hepatitis C virus (HCV) infection. Int J Med Sci 2006; 3: 41–46.

    Google Scholar 

  31. Saeed AA, Al-Admawi AM, Al-Rasheed A, Fairclough D, Bacchus R, Ring C et al. Hepatitis C virus in Egyptian blood donors in Riyadh. Lancet 1991; 33: 359–360.

    Google Scholar 

  32. El-Hazmi MM . Prevalence of HBV, HCV, HIV-1, 2 and HTLV-I/II infections among blood donors in a teaching hospital in the Central region of Saudi Arabia. Saudi Med J 2004; 25: 26–33.

    PubMed  Google Scholar 

  33. Mahaba H, el-Tayeb Ael-K, Elbaz H . The prevalence of antibodies to hepatitis C virus in Hail region, Saudi Arabia. J Egypt Public Health Assoc 1999; 74: 69–80.

    CAS  PubMed  Google Scholar 

  34. El Guneid AM, Gunaid AA, O′Neill AM, Zureikat NI, Coleman JC, Murray-Lyon IM . Prevalence of hepatitis B, C and D virus markers in Yemeni patients with chronic liver disease. J Med Virol 1993; 40: 330–333.

    Article  CAS  PubMed  Google Scholar 

  35. Al-Ahdal MN, Rezeig MA, Kessie G . Genotyping of hepatitis C virus isolates from Saudi patients by analysis of sequences from pcr-amplified core region of the virus genome. Ann Saudi Med 1997; 17: 601–604.

    Article  CAS  PubMed  Google Scholar 

  36. Osoba AO . Hepatitis C virus genotypes in Saudi Arabia. Saudi Med J 2002; 23: 7–12.

    PubMed  Google Scholar 

  37. Bdour S . Hepatitis C virus infection in Jordanian haemodialyis units, serological diagnosis and genotyping. J Med Microbiol 2002; 51: 700–704.

    Article  PubMed  Google Scholar 

  38. Shobokshi OA, Serebour FE, Skakni L, Al Safy YH, Ahdal MN . Hepatitis C genotypes and subtypes in Saudi Arabia. J Med Virol 1999; 58: 44–48.

    Article  CAS  PubMed  Google Scholar 

  39. Kabir A, Alavian S, Keyvani H . Distribution of hepatitis C virus genotypes in patients infected by different sources and its correlation with clinical and virological parameters: a preliminary study. Comp Hepatol 2006; 5: 4; doi:10.1186/1476-5926-5-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Aljurf M, Gyger M, Alrajhi A, Sahovic E, Chaudhri N, Musa M et al. Mycobacterium tuberculosis infection in allogeneic bone marrow transplantation patients. Bone Marrow Transplant 1999; 24: 551–554.

    Article  CAS  PubMed  Google Scholar 

  41. Centers for Disease Control and Prevention; Infectious Diseases Society of America; American Society of Blood and Marrow Transplantation. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients; recommendations of the CDC, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2000; 6: 659–734.

    Google Scholar 

  42. Mahmoud HK . Schistosomiasis as a predisposing factor to veno-occlusive disease of the liver following allogeneic bone marrow transplantation. Bone Marrow Transplant 1996; 17: 401–403.

    CAS  PubMed  Google Scholar 

  43. Roll Back Malaria Monitoring and Evaluation in Pakistan– WHO report http://www.rbm.who.int/wmr2005/profiles/paquistan.pdf.

  44. Gratwohl A, Baldomero H, Horisberger B, Schmid C, Passweg J, Urbano-Ispizua A . Accreditation Committee of the European Group for Blood and Marrow Transplantation (EBMT). Current trends in haematopoietic stem cell transplantation in Europe. Blood 2002; 100: 2374–2386.

    Article  CAS  PubMed  Google Scholar 

  45. Gratwohl A, Baldomero H, Frauendorfer K, Urbano-Ispizua A, Joint Accreditation Committee, International Society for Cellular Therapy; European Group for Blood and Marrow Transplantation. EBMT activity survey 2004 and changes in disease indication over the past 15 years. Bone Marrow Transplant 2006; 37: 1069–1085.

    Article  CAS  PubMed  Google Scholar 

  46. Gratwohl A, Baldomero H, Frauendorfer K, Niederwieser D . Why are there regional differences in stem cell transplantation activity? An EBMT analysis. Bone Marrow Transplant 2008; 42: S7–S10.

    Article  PubMed  Google Scholar 

  47. Gratwohl A, Baldomero H, Schwendener A, Gratwohl M, Apperley J, Niederwieser D et al. Predictability of hematopoietic stem cell transplantation rates. Haematologica 2007; 92: 1679–1686.

    Article  PubMed  Google Scholar 

  48. Gratwohl A, Baldomero H, Passweg J, Frassoni F, Niederwieser D, Schmitz N et al., for the Accreditation Committee of the European Group for Blood and Marrow Transplantation (EBMT) in cooperation with the Working Parties Acute (ALWP) and Chronic Leukemias (CLWP) and the Lymphoma Working Party Hematopoietic stem cell transplantation for hematological malignancies in Europe. Hematopoietic stem cell transplantation for hematological malignancies in Europe. Leukemia 2003; 17: 941–959.

    Article  CAS  PubMed  Google Scholar 

  49. Gratwohl A, Passweg J, Baldomero H, Horisberger B, Urbano-Ispizua A, for the Accreditation Committee of the European Group for Blood and Marrow Transplantation (EBMT). Economics, health care systems and utilization of hematopoietic stem cell transplants in Europe. Br J Haemtol 2002; 117: 451–468.

    Article  Google Scholar 

  50. Gratwohl A, Baldomero H, Schwendener A, Gratwohl M, Urbano-Ispizua A, Frauendorfer K . Haematopoietic stem cell transplants for chronic myeloid leukemia in Europe. Impact of cost considerations. Leukemia 2007; 21: 383–386.

    Article  CAS  PubMed  Google Scholar 

  51. Gajewski JL . Do affluent societies have the only options for the best therapy. Leukemia 2007; 3: 387–388.

    Article  Google Scholar 

  52. Russell NH, Szydlo R, McCann S, Potter MN, Craddock C, Towlson K et al. British Society for Blood and Marrow Transplantation. The use of a national transplant registry to benchmark transplant outcome for patients undergoing autologous and allogeneic stem cell transplantation in the United Kingdom and Ireland. Br J Haematol 2004; 124: 499–503.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank and acknowledge all participating physicians and centers in the Eastern Mediterranean region, who forwarded their data to the corresponding author from their country.

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Correspondence to M D Aljurf.

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Aljurf, M., Zaidi, S., El Solh, H. et al. Special issues related to hematopoietic SCT in the Eastern Mediterranean region and the first regional activity report. Bone Marrow Transplant 43, 1–12 (2009). https://doi.org/10.1038/bmt.2008.389

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  • DOI: https://doi.org/10.1038/bmt.2008.389

Keywords

  • HSCT programs
  • Eastern Mediterranean
  • regional activity
  • donor availability
  • genetic issues
  • pattern of infections

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