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The stem cell transplant program in Pakistan--the first decade.

Ts Shamsi¹, K Hashmi, S Adil

¹Bismillah Taqee Institute of Health Sciences and Blood Diseases Center, Karachi, Pakistan. shamsi@super.net.pk

Bone Marrow Transplantation

|September 25, 2008

Summary

Stem cell transplantation (SCT) in Pakistan has advanced significantly, offering curative options for fatal blood diseases. Despite challenges like financial constraints, promising survival rates are achieved, highlighting the need for government support.

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Area of Science:

Hematology
Transplant Medicine
Oncology

Background:

Stem cell transplantation (SCT) is a life-saving treatment for various hematological diseases.
SCT services in Pakistan commenced in 1995, with significant growth in allogeneic bone marrow transplantation (BMT) since 1999.
Key indications include aplastic anemia, beta-thalassemia major, and hematological malignancies.

Purpose of the Study:

To review the development and current status of stem cell transplantation in Pakistan.
To highlight the unique characteristics and challenges of SCT in the Pakistani context.
To assess the early outcomes and survival rates of SCT procedures.

Main Methods:

Retrospective analysis of SCT procedures performed in Pakistan.
Review of transplant indications, donor types, and patient characteristics.
Evaluation of transplant-related mortality and long-term survival rates.

Main Results:

Over 350 allogeneic SCTs and 50 autologous SCTs have been performed across multiple centers.
Majority of transplants are allogeneic, with HLA-identical sibling donors used in 70% of cases.
Promising survival rates: 78% (aplastic anemia), 72% (beta-thalassemia major), 49% (leukemia); with 10-20% transplant-related mortality.

Conclusions:

SCT in Pakistan has shown promising early results despite facing significant financial and infrastructural hurdles.
Unique challenges include a high prevalence of CMV-positive donor-recipient pairs and specific infectious disease concerns (fungal infections, TB, malaria).
Sustained growth and wider accessibility of SCT necessitate increased government support, improved infrastructure, and human resource development.