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Challenges in managing graft-versus-host disease in developing countries: a perspective

Bone Marrow Transplantation volume 54, pages 641–647 (2019)Cite this article

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Abstract

Hematopoietic cell transplant (HCT) activity is increasing worldwide due to safer techniques, widening indications, and more availability of donors. New HCT centers have recently been established in many developing countries including Asian and African countries. Due to limited resources, logistic, political, and social issues in developing countries, the treatment of orphan diseases like graft-versus-host disease (GVHD) can be challenging. We intended to delineate the current issues that institutions and clinicians face in managing GVHD. We conducted a comprehensive systematic electronic review of peer-reviewed published articles on GVHD management in developing countries. We used PubMed, Cochrane, and Embase databases as our primary source of data. Studies that were included described the treatments for both acute and chronic GVHD. Consensus on the use of high-dose methyl-prednisone and prednisolone as the initial therapy was widely accepted and used in practice. Socio-economic factors were found to be the major factor involved in GVHD management in lower income patients. Delayed diagnosis and treatment, lack of availability of healthcare professionals, lack of knowledge among cancer patients, and poverty are major concerns in the developing world. For optimal management, HCT programs should develop systems in place for long-term follow-up of HCT survivors and have a low threshold to initiate treatments for GVHD early. Awareness and health policy programs must be initiated at the grass-root level for long-term management of these survivors in developing countries.

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Author information

Authors and Affiliations

  1. Shifa College of Medicine, Islamabad, Pakistan

    Muhammad Sabih Saleem

  2. Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    Mahmoud Aljurf & Shahrukh K. Hashmi

  3. Department of Hematology, Christian Medical College, Vellore, India

    Alok Srivastava

  4. Department of Hematology, National Institutes of Blood Diseases, Karachi, Pakistan

    Tahir Shamsi

  5. Department of Hematology, Dao Pei Lu Hospital, Beijing, China

    Pei Hua Lu

  6. Department of Pediatric Hematology/Oncology, Tehran University of Medical Sciences, Tehran, Iran

    Amir Ali Hamidieh

  7. National Cancer Institute, Cairo University, Cairo, Egypt

    Alaa El Haddad

  8. Department of Internal Medicine, Mayo Clinic, Rochester, NY, USA

    Shahrukh K. Hashmi

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Contributions

M.S.S. and S.K.H. wrote the first draft of the manuscript. All authors contributed substantially to the conception, acquisition, analysis, and interpretation of the data for the work and approved the final approval of the version to be published.

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Correspondence to Shahrukh K. Hashmi.

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Saleem, M.S., Aljurf, M., Srivastava, A. et al. Challenges in managing graft-versus-host disease in developing countries: a perspective. Bone Marrow Transplant 54, 641–647 (2019). https://doi.org/10.1038/s41409-018-0333-z

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