Making Allogeneic Bone Marrow Transplantation Available to Patients in Developing Countries: The Mexican Experience

Abstract

Non-myeloablative allogeneic stem cell transplantation (NST) has been one of the most exciting developments in the treatment of hematologic malignancies in the last years. Since 1999, we have chosen to employ in Mexico a regi- men to conduct NST, introducing some changes with the main goal of decreasing the cost of the procedure and in turn, making it available to a larger number of patients in developing countries. Using this method we have done over 400 al- lografts in Latin American patients with different both malignant and non-malignant diseases: Chronic myelogenous leu- kemia, acute myelogenous leukemia, acute lymphoblastic leukemia, myelodysplasia, thalassemia major, relapsed Hodg- kins disease, Blackfan-Diamond syndrome, adrenoleukodystrophy, Hunters syndrome, aplastic anemia and several solid tumors. In the whole group, the median granulocyte recovery time to 0.5 x 10 9 /L was 13 days, whereas the median platelet recovery time to 20 x 10 9 /L was 12 days. Around one third of the patients did not need red blood cell transfusions and also one third did not need platelet transfusions. In more than 70% of cases the procedure could be completed totally on an outpatient basis. The follow up time of the patients ranges between 30 and 2000 days. Approximately 50% of the al- lografted individuals have developed acute graft versus host disease (GVHD), whereas around 30% developed chronic GVHD. The median post-allograft overall survival (SV) has not been reached and the 2000 day overall SV is 54%, the 100-day mortality being 16%. In the whole group of patients, the median cost of each NST was 18 000 USD, a figure which contrasts with that informed from developing countries. More than 95% of the patients who were allografted in Mexico and Latin America using this method could not have afforded the cost of a conventional or more expensive stem cell transplant; accordingly, this procedure has enabled doctors in Mexico and Latin America to offer this therapeutic ap- proach to a larger number of individuals.