Background

The advent of new immunomodulation techniques has significantly improved the outcome of haploidentical hematopoietic cell transplantation (haplo-HCT), making it an alternative in the absence of HLA-matched donor transplantation, especially in resource-constrained countries, due to the overall reduced transplantation cost.

Pakistan is the sixth most populous country with >200 million inhabitants. The country is facing a high disease burden of thalassemia, bone marrow failure syndromes, leukemias. and other genetic diseases. An estimated 10 000 patients need HCT annually, and in 2016, 9 in every 10 million people underwent HCT.

Being a resource-constrained country, Pakistan lacks the infrastructure for a matched unrelated donor registry or cord blood banks. The transplant activity is likely to increase due to recent developments in haplo-HCT. We present our experience in establishing a haplo-HCT facility through a capacity enhancement program offered by the American Society of Hematology (ASH).

Methods

With the objective of establishing a haplo-HCT program at the country’s largest HCT center, I received 3 months of clinical training at the MD Anderson Cancer Center, University of Texas (Houston, TX), through the ASH Visitor Training Program from October to December 2016. The training involved haplo-HCT–related laboratory procedures, administration of conditioning protocols, and management of pre- and posttransplant complications.

On my return, I worked closely with the team of bone marrow transplant specialists to develop a halpo-HCT facility at our institute. This included high-resolution HLA typing, careful donor selection among available donors, and formulation of conditioning protocols for different benign and malignant hematological disorders using available resources.

Outcome

Figure 1.

(A) Haplo-HCT data after the ASH Visitor Training Program. (B) Overall survival. (C) Disease-free survival.

Figure 1.

(A) Haplo-HCT data after the ASH Visitor Training Program. (B) Overall survival. (C) Disease-free survival.

Conclusions

Haploidentical transplantation has opened new horizons for patients lacking fully matched HLA donors for HCT.

Conflict-of-interest disclosure: The author declares no competing financial interests.

Correspondence: Mehreen Ali Khan, Armed Forces Bone Marrow Transplant Centre/National Institute of Blood & Marrow Transplant, Rawalpindi, Pakistan; e-mail: mehreen35@hotmail.com.