Hematopoietic stem cell transplantation in Thailand. S Issaragrisil. Division of Hematology, Department of Medicine, Chulabhorn BMT Center, Siriraj Hospital, ...
Bone Marrow Transplantation (2008) 42, S137–S138 & 2008 Macmillan Publishers Limited All rights reserved 0268-3369/08 $30.00
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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 1986. At present, there are FOUR active centers: Siriraj, Ramathibodi, Chulalongkorn and Pramongkutklao Hospitals. The annual number of transplants varies from 120 to 150 cases. Although the number of eligible patients is high, only a proportion of the patients can undergo hematopoietic SCT due to the high cost of the procedure. The overall results are comparable to those reported in the Western countries. The incidence of acute GVHD is low, whereas chronic GVHD is high, especially in those who receive PBSC. Bone Marrow Transplantation (2008) 42, S137–S138; doi:10.1038/bmt.2008.142 Keywords: hematopoietic SCT; Thailand; GVHD
Thailand is one of the ASEAN countries with a population of 60 million. In Thailand, hematological malignancies and other hematological diseases are prevalent. Hematological malignancies including acute leukemia, CML, non-Hodgkin’s lymphoma and multiple myeloma are as common as in Western countries, whereas, Hodgkin’s lymphoma and CLL are rare in the Far East.1 Aplastic anemia has long been believed to be of high incidence in this region. On the basis of a recent epidemiological study, the annual incidence of aplastic anemia is 4 per million, which is twice as high as in Europe and Israel.2 Thalassemias and hemoglobinopathies, such as Hb E and Hb Constant Spring, are of high prevalence in this region. The frequency of b-thalassemia varies from 30–40% and b-thalassemia 3–9%. Hb E is the hallmark of Southeast Asia with the highest frequencies of 50–60% at the junction of Thailand, Laos and Cambodia. There are more than 60 clinical syndromes with different gene interactions. Homozygous b-thalassemia and Hb E/b-thalassemia are the most severe clinical syndromes in which the patients can be born alive.1 The first BMT was performed in a patient with aplastic anemia on 9 June 1986. The BMT unit was first established at Siriraj Hospital on 18 July 1988.3,4 Up to the present, there are another three BMT units including the Ramathibodi, Chulalongkorn and Pramongkutklao hospitals.
The currently active programs are hematopoietic SCT for thalassemia, allogeneic SCT for hematological malignancies and autologous SCT for malignant lymphoma and multiple myeloma. Approximately 120–150 patients are being transplanted in Thailand annually. About half of them are allogeneic and the rest are autologous SCT. The program at Siriraj Hospital emphasizes allogeneic SCT for thalassemia5 and hematological malignancies. Ramathibodi Hospital performs SCT for thalassemia in children; Chulalongkorn Hospital has program on SCT for hematological malignancies and thalassemia. The overall results of hematopoietic SCT are more or less 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. The first case of sibling cord blood transplantation was successfully performed in a patient with Hb E/b-thalassemia.6 Up to the present, 20 patients underwent sibling cord blood transplantation. Hematological recovery is usually delayed, especially platelet recovery. In some patients, there are no engraftments. Subsequently, unrelated BMT was performed in patients with severe thalassemias.7 In those with class 3 thalassemia, reduced intensity hematopoietic SCT is being used with success. The incidence of acute GVHD is low, approximately 15–20%. Acute GVHD more than grade II is only less than 10%. Chronic GVHD is more common in those undergoing PBSC. Cytomegalovirus infection is not common. It usually occurs in patients with hematological malignancies who previously receive heavy chemotherapy. The cost of hematopoietic SCT is expensive, approximately US$25 000, and therefore not all eligible patients can afford the therapy. Hematopoietic SCT will be available only for those who are in government services or those who have health-care insurance or those who can afford the expense. Only a few patients can be supported by the hospitals.
Acknowledgements Correspondence: Dr S Issaragrisil, Division of Hematology, Department of Medicine, Chulabhorn BMT Center, Siriraj Hospital, Mahidol University, Bangkok, Thailand
S Issaragrisil is a Senior Research Scholar of Thailand Research Fund. This work was supported by Thailand Research Fund Grant no. 4880007.
Hematopoietic SCT in Thailand S Issaragrisil
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Conflict of interest The author declared no financial interests.
References 1 Wasi P, Piankijagum A, Issaragrisil S. Geographical variation in blood disease. Southeast Asia. In: Weatherall DJ, Ledingham LGG, Warrel DA (eds). Oxford Textbook of Medicine. Oxford Medical Publications: Oxford, Melbourne, New York, 1987, pp 19.266–19.268. 2 Issaragrisil S, Kaufman DW, Anderson T, Chansung K, Leaverton PE, Shapiro S et al. The epidemiology of aplastic anemia in Thailand. Blood 2005; 107: 1299–1307. 3 Issaragrisil S. Bone marrow transplantation in Thailand. Bone Marrow Transplant 1994; 13: 721–723.
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4 Issaragrisil S, Visuthisakchai S, Piankijagum A, Suvatte V, Chandanayingyong D, Mahasandana C et al. Bone marrow transplantation at Siriraj Hospital. Thai J Hematol Transf Med 1995; 1: 15–25. 5 Issaragrisil S, Visuthisakchai S, Suvatte V, Chandanayingyong D, Piankijagum A, Mahasandana C et al. Bone marrow transplantation for thalassemia in Thailand. Bone Marrow Transplant 1993; 12 (Suppl 1): 42–44. 6 Issaragrisil S, Visuthisakchai S, Suvatte V, Tanphaichitr VS, Chandanayingyong D, Schreiner T et al. Cord blood transplantation in a patient with thalassemia. N Engl J Med 1995; 332: 367–369. 7 Hongeng S, Pakakasama S, Chuansumrit A, Sirachaina N, Sura T, Ungkanont A et al. Reduced intensity stem cell transplantation for treatment of class 3 Lucarelli severe thalassemia patients. Am J Hematol 2007; 82: 1095–1098.
