Hematopoietic Stem Cell Transplantation in Thailand

REVIEW Hematopoietic stem cell transplantation in Thailand

S Issaragrisil

Division of Hematology, Department of Medicine, Chulabhorn BMT Center, Siriraj Hospital, Mahidol University, Bangkok, Thailand

Hematopoietic SCT was first performed in Thailand in The currently active programs are hematopoietic SCT for 1986. At present, there are FOUR active centers: Siriraj, thalassemia, allogeneic SCT for hematological malignan- Ramathibodi, Chulalongkorn and Pramongkutklao Hos- cies and autologous SCT for malignant lymphoma and pitals. The annual number of transplants varies from 120 multiple myeloma. to 150 cases. Although the number of eligible patients is Approximately 120–150 patients are being transplanted high, only a proportion of the patients can undergo in Thailand annually. About half of them are allogeneic hematopoietic SCT due to the high cost of the procedure. and the rest are autologous SCT. The program at Siriraj The overall results are comparable to those reported in the Hospital emphasizes allogeneic SCT for thalassemia5 Western countries. The incidence of acute GVHD is low, and hematological malignancies. Ramathibodi Hospital whereas chronic GVHD is high, especially in those who performs SCT for thalassemia in children; Chulalongkorn receive PBSC. Hospital has program on SCT for hematological malig- Bone Marrow Transplantation (2008) 42, S137–S138; nancies and thalassemia. doi:10.1038/bmt.2008.142 The overall results of hematopoietic SCT are more or less Keywords: hematopoietic SCT; Thailand; GVHD equal to the results reported from the western countries. The long-term disease-free survival is approximately 60%. The nonmalignant disorders have better outcome compared to hematological malignancies. Thailand is one of the ASEAN countries with a population The first case of sibling cord blood transplantation was of 60 million. In Thailand, hematological malignancies and successfully performed in a patient with Hb E/b-thalasse- other hematological diseases are prevalent. Hematological mia.6 Up to the present, 20 patients underwent sibling cord malignancies including acute leukemia, CML, non-Hodg- blood transplantation. Hematological recovery is usually kin’s lymphoma and multiple myeloma are as common delayed, especially platelet recovery. In some patients, as in Western countries, whereas, Hodgkin’s lymphoma there are no engraftments. Subsequently, unrelated BMT and CLL are rare in the Far East.1 Aplastic anemia has was performed in patients with severe thalassemias.7 In long been believed to be of high incidence in this region. On those with class 3 thalassemia, reduced intensity hemato- the basis of a recent epidemiological study, the annual poietic SCT is being used with success. incidence of aplastic anemia is 4 per million, which is twice The incidence of acute GVHD is low, approximately as high as in Europe and Israel.2 Thalassemias and 15–20%. Acute GVHD more than grade II is only less than hemoglobinopathies, such as Hb E and Hb Constant 10%. Chronic GVHD is more common in those under- Spring, are of high prevalence in this region. The frequency going PBSC. of b-thalassemia varies from 30–40% and b-thalassemia Cytomegalovirus infection is not common. It usually 3–9%. Hb E is the hallmark of Southeast Asia with the occurs in patients with hematological malignancies highest frequencies of 50–60% at the junction of Thailand, who previously receive heavy chemotherapy. Laos and Cambodia. There are more than 60 clinical The cost of hematopoietic SCT is expensive, approxi- syndromes with different gene interactions. Homozygous mately US$25 000, and therefore not all eligible patients b-thalassemia and Hb E/b-thalassemia are the most severe can afford the therapy. Hematopoietic SCT will be clinical syndromes in which the patients can be born alive.1 available only for those who are in government services The first BMT was performed in a patient with aplastic or those who have health-care insurance or those who can anemia on 9 June 1986. The BMT unit was first established afford the expense. Only a few patients can be supported at Siriraj Hospital on 18 July 1988.3,4 Up to the present, by the hospitals. there are another three BMT units including the Ramathi- bodi, Chulalongkorn and Pramongkutklao hospitals. Acknowledgements

Correspondence: Dr S Issaragrisil, Division of Hematology, Department S Issaragrisil is a Senior Research Scholar of Thailand Research of Medicine, Chulabhorn BMT Center, Siriraj Hospital, Mahidol Fund. This work was supported by Thailand Research Fund University, Bangkok, Thailand Grant no. 4880007. Hematopoietic SCT in Thailand S Issaragrisil S138 Conﬂict of interest 4 Issaragrisil S, Visuthisakchai S, Piankijagum A, Suvatte V, Chandanayingyong D, Mahasandana C et al. Bone marrow The author declared no ﬁnancial interests. transplantation at Siriraj Hospital. Thai J Hematol Transf Med 1995; 1: 15–25. References 5 Issaragrisil S, Visuthisakchai S, Suvatte V, Chandanayingyong D, Piankijagum A, Mahasandana C et al. Bone marrow 1 Wasi P, Piankijagum A, Issaragrisil S. Geographical variation transplantation for thalassemia in Thailand. Bone Marrow in blood disease. Southeast Asia. In: Weatherall DJ, Ledingham Transplant 1993; 12 (Suppl 1): 42–44. LGG, Warrel DA (eds). Oxford Textbook of Medicine. Oxford 6 Issaragrisil S, Visuthisakchai S, Suvatte V, Tanphaichitr VS, Medical Publications: Oxford, Melbourne, New York, 1987, Chandanayingyong D, Schreiner T et al. Cord blood trans- pp 19.266–19.268. plantation in a patient with thalassemia. N Engl J Med 1995; 2 Issaragrisil S, Kaufman DW, Anderson T, Chansung K, 332: 367–369. Leaverton PE, Shapiro S et al. The epidemiology of aplastic 7 Hongeng S, Pakakasama S, Chuansumrit A, Sirachaina N, anemia in Thailand. Blood 2005; 107: 1299–1307. Sura T, Ungkanont A et al. Reduced intensity stem cell trans- 3 Issaragrisil S. Bone marrow transplantation in Thailand. Bone plantation for treatment of class 3 Lucarelli severe thalassemia Marrow Transplant 1994; 13: 721–723. patients. Am J Hematol 2007; 82: 1095–1098.

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