David Gómez-Almaguer, Md, Facp.
Universidad Autonoma De Nuevo León, México. Chair of Council of the International Society Of Hematology
The high cost of hematopoietic cell transplantation (HCT) is a barrier for people living in undeveloped countries, therefore any efforts to make this procedure more affordable are welcome.
Nowadays, there is lot of information regarding the life-saving capacity of haematopoietic cell transplantation (HCT), also known as bone marrow transplantation. Patients worldwide have been treated with the different methods of this procedure that includes the sourcing of cells from bone marrow, peripheral blood and cord blood.
The HCT is classified as autologous – in that one’s own stem cells can be removed and used for treatment – and also allogeneic – where stem cells can be provided by a donor. The goal of the former, auto-HCT, is to give the patient chemotherapy and then rescue them with their own previously saved stem cells.
Allogeneic HCT, on the other hand, can have different sources of cells, depending on the match of HLA antigens. It can be obtained from a sibling donor, although, ideally the donor would be HLA identical with the patient. When an identical sibling is not available, the cell could be taken from unrelated donors that can be found on international registries. However, a new and exciting way to collect stem cells comes from haploidentical donors, i.e. half identical donors.
HCT was developed in order to save many lives and has been shown to be a cost-effective therapeutic measure.
Virtually every patient has a compatible, half identical donor
In international registries, more than 25 million healthy individuals have volunteered to serve as stem cell donors, but nowadays, haploidentical allogeneic HCT is becoming more popular because the biological barriers to perform it have been overcome, and virtually every patient has a donor.
Many diseases, both malignant and non-malignant have been successfully treated with HCT. Allogeneic HCT is mainly used in acute leukemias and aplastic anemia, and autologous HCT is routinely performed in multiple myeloma patients all over the world. But many other diseases like lymphomas, autoimmune and benign haematological diseases could be treated with this procedure.
How can we make HCT more affordable?
HCT was developed in order to save many lives and has been shown to be a cost-effective therapeutic measure. Since it is not widely available to every patient who could be cured, many modifications have been made to this procedure to make it more affordable.
There are exciting developments coming from India and Mexico, describing strategies for performing HCT in developing countries. There are several lessons learned: the use of affordable generic drugs whenever possible, avoiding cryopreservation of stem cells, using reduced-intensity conditioning and an outpatient based HCT. Other measures that could be useful include utilising peripheral blood as a stem cell source; limiting expensive and repetitive diagnostic studies; and avoiding excessive prophylactic blood transfusions.
ISH’s mission to cure HCT patients
The International Society of Hematology is devoted to promoting the best available therapy to patients all over the world. But, most of all, we are interested in promoting methods that reduce the cost of procedures like HCT, in order to bring this kind of therapy to more patients in the so-called low- and middle-income countries. There is experience in less developed countries with lowering costs of transplantation with the aim of making it more available to all patients, regardless of their socioeconomic status. This gives more patients the possibility of cure.