Surviving Stem Cell Transplantation Program In War Time In Syria

Substantial medical care deterioration occurred during Syrian civil war, including complete destruction of over 50 hospitals and 400 medical centers. We report result of 17 cases of stem cell transplantation in private sector in Damascus in Syria in the period between 2012 and 2013 during major hardship and shortage of all medical care.

Stem cell transplantation is standard of care for certain hematologic malignancies. This sophisticated treatment has not been developed in Syria for economic and logistic reasons. Our group of six doctors adamantly worked hard over four years to establish local stem cell transplantation unit in private sector. We were able to start everything from scratch engineering the unit and training of all human resources. By the time we are ready to operate our first case of stem cell transplantation we had major obstacle, civil war eruption all over Syria. Some of our trained human resources has to leave the country other unable to reach the center. There was major medical supplies and medications shortage due to embargo and flight restrictions to Syria. With great difficulties and neighboring medical community assistance we were able to keep up the work and perform in the first year of operation seventeen cases of autologous stem cell transplantation.

From May2012 –June 2013 we admitted 17 cases for autologous stem cell transplantation. Median age 36 years half of them from Damascus and the rest from all other municipals. Relapse Hodgkin’s and none Hodgkin’s lymphoma, and consolidation multiple myeloma, are the majority of stem cell indication. CD 34 counts collected for patients ranged from 3-16⁶ million cell/ KG (Median 6⁶) with viability 90-99% (Median 95%) one week after freezing. Most conditioning regimens were standard BEAM and Melphelan 200. Median white blood cells engraftment to ANC 500 was D +13. Median platelets engraftment to platelets transfusion free was D +22. Infections are the major morbidity presented as febrile neutropenia. Grade III and IV Mucositis occurred in 35% of patient. All patient required transfusion support with PRBC’s and Random Donor Platelets while 25% of the required total parental nutrition. Two of the patients died during the first 100 days of transplant, one from massive pulmonary hemorrhage d+16, who was heavily pretreated with radiation and previous stem cell transplantation, the other case, none Hodgkin’s lymphoma who is heavily pretreated had engraftment failure and died from multi-organ failure on D+41.