Immunophenotypic and genetic analyses have become routine in the diagnosis and monitoring of hematological malignancies in the developed world. However, these advances have not been translated to developing countries. The technology required is expensive and has previously not been available. Peshawar, the capital of Khyber Pakhtunkhwa province of Pakistan, caters to the health needs of ∼30 million people in the province. Despite huge numbers of patients, most hospitals lack an advanced laboratory for genetic and immunophenotypic diagnosis and monitoring of blood diseases, and diagnoses are made on morphology alone. We sought to establish a diagnostic facility using flow cytometry and genetic analysis that is tailored to the diseases that we encounter, but that is also affordable. Khyber Medical University and Rehman Medical Institute (RMI) in Peshawar have been working with the University of Glasgow and affiliated hospitals to establish such a laboratory in Peshawar.
Molecular diagnostics for therapeutically targetable genetic mutations in leukemia
The World Health Organization classification uses genetic mutations for the diagnosis and classification of a number of acute and chronic malignancies. The identification of these mutations is critical for patient management. The following were therefore prioritized:
Flow cytometry for immunophenotypic diagnosis and monitoring of leukemia
The establishment of a flow cytometry laboratory requires careful selection of a flow cytometer, technical and clinical training on flow-based diagnosis, and the design of affordable antibody panels of high diagnostic yield. Under the American Society of Hematology Visitor Training Program, Y.Y. undertook a 12-week attachment to the diagnostic flow cytometry laboratory at Gartnavel Hospital, Glasgow. Y.Y. was trained in flow cytometry technology using a platform relevant to that planned for use at RMI.
We have successfully initiated a molecular diagnostic hematology laboratory in Peshawar. Ongoing training of technical staff will ensure sustainability of this service. We are now in a position to introduce a dedicated flow cytometry service in Peshawar essential to our needs. The low test costs will ensure that such technology is accessible and routinely available to a larger segment of our population. This demonstrates that mentoring and guidance from laboratories in the developed world can be highly effective in helping establish an affordable and accessible diagnostic hematology service in low-/middle-income countries.
Conflict-of-interest disclosure: M.C.: Incyte (research funding, honoraria, speakers’ bureau, membership on board of directors or advisory committees); Bristol-Myers Squibb (research funding, honoraria, speakers’ bureau, membership on board of directors or advisory committees). C.H.: Jazz Pharmaceuticals (consultancy, other). The remaining authors declare no competing financial interests.
Correspondence: Yasar Mehmood Yousafzai, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan; e-mail: email@example.com.