Establishment of the first bone marrow transplant program in francophone sub-Saharan Africa: clinical case and future...

Haematopoietic stem cell transplantation (HSCT) offers curative potential for several malignant and non-malignant hematologic disorders. Despite its proven efficacy, access to HSCT in sub-Saharan Africa remains limited, especially in francophone countries, due to the lack of infrastructure, cryobiology facilities and trained personnel. Senegal recently launched a national initiative to establish its first HSCT program.

We report the first autologous HSCT performed in Senegal in February 2025 at Dalal Jamm University Hospital, in a 51-year-old man diagnosed with high-risk IgA-lambda multiple myeloma (ISS stage III, del17p). Mobilisation was achieved using filgrastim (10 µg/kg/day for 7 days). A total of 2.8 × 10⁶ CD34⁺ cells/kg were collected by apheresis and stored at 4°C for 24 hours without cryopreservation. Conditioning consisted of high-dose intravenous melphalan (200 mg/m²) followed by reinfusion of the graft on day 0. Hematologic recovery occurred by day +10, with transient grade 3 anemia and grade 4 thrombocytopenia requiring transfusion support. The main complications were manageable febrile neutropenia and mild gastrointestinal and renal toxicities. The patient was discharged on day +17, remained infection-free and achieved complete hematologic and biochemical remission at five months post-transplant. Consolidation therapy with bortezomib-thalidomide-dexamethasone and lenalidomide maintenance was subsequently administered.

This first non-cryopreserved autologous HSCT in Senegal demonstrates the feasibility, safety and cost-effectiveness of transplantation under resource-limited conditions. Establishing local cryopreservation and molecular diagnostic capabilities will be essential to enable tandem and allogeneic HSCT, ensuring sustainability and regional self-sufficiency in advanced hematologic care.