Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

High-dose chemotherapy and autotransplants for plasma cell myeloma in Jordan

Bone Marrow Transplantation volume 53, pages 1349–1350 (2018)Cite this article

Subjects

Jordan (officially The Hashemite Kingdom of Jordan) is a small country (89,341 kmE + 2; 2016 population estimate, 9.5 million) with limited resources (per capita GDP $12,300 USD; World Rank, 123) and increasing cancer incidence including haematological neoplasms. In Jordan, there are four transplant centres performing 200–250 transplants annually, one-half allogeneic and the others autologous with a rate of 2–2.5/10 × 10E + 5 population. This is about fivefold lower than the European Union and United States [1, 2]. Number of Jordanians who might benefit from a haematopoietic cell transplant is increasing. There are, however, substantial barriers to meeting this need including the following: (1) few transplant centres; (2) few transplant specialists; (3) no bone marrow donor registry; (4) high cost; (5) unavailability of some commonly used transplant-related drugs such as carmustine and thiotepa; (6) no accommodations for patients and families near transplant centres; and (7) high proportion of non-Jordanians with no insurance coverage including many recent Syrian refugees. Consequently, many persons who might benefit from a transplant are never referred or are referred with advanced disease and substantial co-morbidities because of the complex referral system and lack of team coordination. Cancer treatment including transplants is free to Jordanian citizens, but not to non-citizens whose transplant costs are paid for out-of-pocket charities and rarely by their governments.

We describe outcomes of 94 consecutive persons with plasma cell myeloma receiving an autotransplant in the Department of Hematology and Oncology at King Hussein Cancer Center from January 2008 to December 2015. Written informed consent and Institutional Review Board approval were obtained for all subjects. Diagnosis was based on the International Myeloma Working Group criteria [3]. Subject-, disease- and transplant-related variables are shown in the Table 1. Outcomes were evaluated using the European Society for Blood and Marrow Transplantation response criteria [4]. Analyses of immunoglobulin levels, serum and urine protein electrophoreses, free immunoglobulin light chains and imaging studies were done in most subjects.

Table 1 Subject-, disease- and transplant-related variables
Full size table

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Passweg JR, Baldomero H, Bader P, Bonini C, Cesaro S, Dreger P, for the European Society for Blood and Marrow Transplantation (EBMT). et al. Hematopoietic stem cell transplantation in Europe 2014: more than 40,000 transplants annually. Bone Marrow Transplant. 2016;51:786–92.

    Article  CAS  Google Scholar 

  2. D’Souza Anita, Lee Stephanie, Zhu Xiaochun, et al. Current use and trends in hematopoietic cell transplantation in the United States. Biol Blood Marrow Transplant. 2017;23:1417–21.

    Article  Google Scholar 

  3. Rajkumar SV. Updated diagnostic criteria and staging system for multiple myeloma. Am Soc Clin Oncol Educ Book. 2016;35:e418–23. https://doi.org/10.14694/EDBK_159009

    Article  PubMed  Google Scholar 

  4. Bladé J, Samson D, Reece D, Apperley J, Björkstrand B, Gahrton G, et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Myeloma Subcommittee of the EBMT—European Group for Blood and Marrow Transplant. Br J Haematol. 1998;102:1115–23.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Bone Marrow Transplantation Unit, Department of Internal Medicine, King Hussein Cancer Center, P.O. Box 1269 Al-Jubeiha, Amman, 11941, Jordan

    Khalid Halahleh, Mohammad Ma’koseh, Husam Abu-Jazar, Sameer Yaser, Hani Howar, Mohamad AL-Rawashdeh, Nilly Hussein & Mahmoud Sarhan

  2. Department of Cell Therapy and Applied Genomics, Haematology Research Centre, London, UK

    Abdelghani Tbakhi

  3. Department of Pharmacy, Haematology Research Centre, London, UK

    Rula Najjar

  4. Office of Scientific Affairs and Research and Biostatistics Unit, Research Office, Amman, Jordan

    Dalia Al-Rimawi

  5. Haematology Researh Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK

    Robert Peter Gale

Authors
  1. Khalid Halahleh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohammad Ma’koseh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Husam Abu-Jazar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sameer Yaser
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hani Howar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mohamad AL-Rawashdeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Abdelghani Tbakhi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rula Najjar
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nilly Hussein
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Dalia Al-Rimawi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Robert Peter Gale
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Mahmoud Sarhan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Khalid Halahleh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Halahleh, K., Ma’koseh, M., Abu-Jazar, H. et al. High-dose chemotherapy and autotransplants for plasma cell myeloma in Jordan. Bone Marrow Transplant 53, 1349–1350 (2018). https://doi.org/10.1038/s41409-018-0201-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41409-018-0201-x

Search

Advanced search

Quick links