The simplification of the SCT procedures in developing countries has resulted in cost-lowering and availability to more patients

Abstract

In order to simplify and cutting down expenses of the bone marrow transplantation procedures we have made some efforts, trying to provide the best transplantation technique for the individual patient with scarce resources. In relation with the source of stem cells, we have found very attractive the use of peripheral blood stem cells (PBSC) instead of bone marrow cells. This procedure can produce substantially more rapid engraftment than observed with bone marrow. The rapid hematopoietic reconstitution in the recipient of PBSC lower expenses stemming from the use of antibiotics, blood bank products and days at the hospital. In Mxico, a country with a large number of cases of severe aplastic anemia we decided to use PBSC to transplant 10 patients with this disease, in order to take advantage of the large number of stem cells that this procedure can provide. We had excellent results in these patients, avoiding the high cost of the conventional transplantation and the use of ATG. In relation to autologous transplantation we have made efforts to perform autografts without the use of freezing devices, keeping the stem cells in liquid form using a conventional blood bank refrigerator for up to 96 hr. This modifications have resulted in diminishing costs and increasing the availability of the procedure to a large number of patients. Finally in Mxico we have had experience with non-myeloablative transplants, and obtained reasonably good results, with a median cost of 18,000 USD per allogeneic transplantation procedure. In some cases this is the only affordable therapeutic option. In developing countries where very few patients can afford the cost of conventional bone marrow transplants, any reasonable effort in the direction of simplification must be welcome.