Establishment of a haploidentical transplantation program in a resource-constrained country

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).

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.

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.