Overcoming barriers for the establishment of a consolidated hematopoietic cell transplantation program in a developing c
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ORIGINAL ARTICLE
Overcoming barriers for the establishment of a consolidated hematopoietic cell transplantation program in a developing country Monica M. Rivera‑Franco1 · Eucario Leon‑Rodriguez1 Received: 19 December 2019 / Revised: 24 June 2020 / Accepted: 28 July 2020 © Japanese Society of Hematology 2020
Abstract The first hematopoietic cell transplantation (HCT) in Mexico was performed at our institution; however, outcomes were suboptimal the following years, until 1998, when a consolidated HCT was established. The aim of this study was to describe the barriers and the implemented strategies to establish a successful HCT program at a referral center in Mexico and to analyze the outcomes. Barriers were detected based on the results from 1980 to 1997. For the analysis of outcomes, a retrospective study was performed including consecutive patients undergoing autologous, allogeneic, and haploidentical HCT. From November 1998 to December 2018, 363 HCTs were performed (autologous, 59%) in 323 patients. Overall non-relapse mortality (NRM) in autologous and allogeneic HCT was 2% and 14%, respectively. The 5-year overall survival was 71% and 57% for autologous and allogeneic HCT, respectively. The cost of the medications was one of the main limitations for the patients and was successfully overcome by the creation of the non-governmental organization “Unidos”. NRM was diminished after reducing the BuCy2 regimen along with the use of bone marrow. Our results highlight that the implementation of unique strategies at our center, led HCT to represent a financially viable and feasible procedure with optimal results. Keywords Barriers · Limited resources · Developing country · Outcomes · Non-relapse mortality
Introduction The first hematopoietic cell transplantation (HCT) in Mexico was performed in 1980 at the National Institute of Medical Sciences and Nutrition “Salvador Zubiran” (INCMNSZ), a National Health Institute in Mexico City, coordinated by the Mexican Ministry of Health. From that year and until 1997, HCTs were sporadically performed (n = 33); the disease-free survival (DFS) and the overall survival (OS) were suboptimal, and the non-relapse mortality (NRM) was high. These outcomes resulted from an unstructured HCT program, institutional limited resources, patient low socioeconomic status, and paucity of population-adapted procedures. Thus, in 1998, according to the discouraging results
* Eucario Leon‑Rodriguez [email protected] 1
Hematopoietic Stem Cell Transplantation Program, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas Y Nutricion Salvador Zubiran, Vasco de Quiroga 15, Belisario Dominguez Seccion XVI, Tlalpan, 14080 Mexico City, Mexico
observed during almost 2 decades, the HCT program was formally established. On the other hand, although Mexico is categorized as an upper-middle income country, almost 50% of the population is vulnerable and lives in poverty [1], and consequently, most Mexicans do not possess healthcare coverage. In 2004, the Mexican Healthcare Univers
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