Latin America: the next region for haematopoietic transplant progress

Haematopoietic cell transplant activity in the 28 countries comprising Latin America is poorly defined. We conducted a voluntary survey of members of the Latin American Bone Marrow Transplantation Group regarding transplant activity 2009–2012. Collated responses were compared with data of transplant rates from the Worldwide Network for Blood and Marrow Transplantation for other geographic regions. Several socio-economic variables were analysed to determine correlations with transplant rates. In total, 94 teams from 12 countries reported 11519 transplants including 7033 autotransplants and 4486 allotransplants. Annual activity increased from 2517 transplants in 2009 to 3263 in 2012, a 30% increase. Median transplants rate (transplant per million inhabitants) in 2012 was 64 (autotransplants, median 40; allotransplants, median 24). This rate is substantially lower than that in North America and European regions (482 and 378) but higher than that in the Eastern Mediterranean and Asia Pacific regions (30 and 45). However, the Latin America transplant rate is 5–8-fold lower than that in America and Europe, suggesting a need to increase transplant availability. Transplant team density in Latin America (teams per million population; 1.8) is 3–4-fold lower than that in North America (6.2) or Europe (7.6). Within Latin America, there is substantial diversity in transplant rates by country partially explained by diverse socio-economic variables including per capita gross national income, health expenditure and physician density. These data should help inform future health-care policy in Latin America

Conducting hematopoietic stem cell transplantation in low and middle income countries

Background Hematopoietic stem cell transplantation (HSCT) is a well-recognized therapeutic procedure; costs limit its widespread use in low and middle income countries (LMIC).Methods Over a 30-year period, we have conducted HSCT in LMIC, making adaptations to the conventional procedures conducted in high-income countries (HIC).Results These salient observations stem from our practice: (1) Start with autologous transplantations in patients with hematological malignancies, specifically multiple myeloma; cell freezing devices are not necessary. (2) Next, consider auto-HSCT in patients with autoimmune diseases. (3) Introduce allogeneic transplants, initially using reduced intensity conditioning regimens. Conducting the HSCT on an outpatient basis is cheaper and safer. (4) Do not build HEPA-filtered rooms nor laminar flow cabins. (5) Do not graft cord blood cells nor start a cord blood blank. (6) Engage in haploidentical transplantations which are more feasible and cost-effective. (7) Matched unrelated donors are extremely expensive. (8) Use generic drugs and biosimilars. (9) Blood product irradiation devices are not necessary. (10) Do not try to reproduce other HSCT programs from HIC; develop your own methods.Conclusions HSCT can be conducted in LMIC with reduced costs and similar efficacy, thus making this therapeutic option affordable for more persons

Artículo de revisión El síndrome de Plaquetas Pegajosas (SPP)

RESUMEN Hace tres décadas Holliday y Mammen describieron a pacientes con enfermedades tromboembólicas arteriales y venosas asociadas con hiperreactividad plaquetaria hereditaria. Ellos llamaron a este fenó-meno protrombótico "síndrome de plaquetas pegajosas" (SPP). El en la agregación plaquetaria inducida por diversas concentraciones de dos agonistas plaquetarios --adenosín difosfato (ADP) y/o epinhiperagregabilidad a ADP y EPI-tipo I, solo a EPI-tipo II, y solo a ADP-tipo III. La hiperagregabilidad se diagnostica por medio de agregometría plaquetaria, aunque exista controversia al hacer el diagnóstico, ya que la concentración de los agonistas no está estandarizada, y no existe un consenso en el porcentaje de agregación plaquetaria. Es importante tomar en cuenta la hiperagregabilidad de los agonistas ADP y EPI, porque se ha relacionado con varias enfermedades adquiridas, como enfermedades metabólicas (diabeenfermedades del sistema inmune). A pesar de que se conoce el fármacos antiplaquetarios, como la aspirina y el clopidogrel revierten la hiperreactividad plaquetaria de los pacientes con SPP, lo que resulta en disminución de la tasa de retrombosis. ABSTRACT Three decades ago Holiday and Mammen described patients with arterial or venous thromboembolic disease associated with inherited platelet hyper reactivity and named this prothrombotic state ¨sticky platelet syndrome¨ (SPS) . SPS has an autosomal dominant trait, -trations of 2 platelet agonists -adenosine diphosphate (ADP) and / or epinephrine (EPI). There are 3 distinct types (hyperaggregability to ADP and EPI -type I, to EPI alone -type II, to ADP alone -type aggregometry, although there has been controversy in diagnosing SPS because the concentration of agonists are not standardized, and there is no consensus on the percent of platelet aggregation that would be considered positive. It is important to bear in mind the platelet hyperaggregability agonists, EPI and ADP, because they have been described in several acquired disorders, such as complex metabolic disease (diabetes mellitus, atherosclerosis) Despite the fact that the phenotype if the disease is well known, aspirin and clopidogrel, have reverted the platelet hyperreactivity of patients with SPS, translating this into a substantial decrease of their re-thrombosis rate