Centro de Hematologia y Medicina Interna, Universidad Popular Autonoma del Estado de Puebla, Puebla, Mexico.
Hospital Samaritano Higienópolis, São Paulo, Brazil.
Hematology. 2022 Dec;27(1):809-812. doi: 10.1080/16078454.2022.2105513.
Hematopoietic stem cell transplantation (HSCT) is a well-recognized therapeutic procedure; costs limit its widespread use in low and middle income countries (LMIC).
Over a 30-year period, we have conducted HSCT in LMIC, making adaptations to the conventional procedures conducted in high-income countries (HIC).
These salient observations stem from our practice: (1) Start with autologous transplantations in patients with hematological malignancies, specifically multiple myeloma; cell freezing devices are not necessary. (2) Next, consider auto-HSCT in patients with autoimmune diseases. (3) Introduce allogeneic transplants, initially using reduced intensity conditioning regimens. Conducting the HSCT on an outpatient basis is cheaper and safer. (4) Do not build HEPA-filtered rooms nor laminar flow cabins. (5) Do not graft cord blood cells nor start a cord blood blank. (6) Engage in haploidentical transplantations which are more feasible and cost-effective. (7) Matched unrelated donors are extremely expensive. (8) Use generic drugs and biosimilars. (9) Blood product irradiation devices are not necessary. (10) Do not try to reproduce other HSCT programs from HIC; develop your own methods.
HSCT can be conducted in LMIC with reduced costs and similar efficacy, thus making this therapeutic option affordable for more persons.
造血干细胞移植（HSCT）是一种公认的治疗方法；但由于成本限制，其在中低收入国家（LMIC）的应用并不广泛。
在过去的 30 年中，我们在 LMIC 中进行了 HSCT，并对高收入国家（HIC）中进行的常规程序进行了调整。
这些显著的观察结果源于我们的实践：（1）从血液系统恶性肿瘤患者的自体移植开始，特别是多发性骨髓瘤；不需要细胞冷冻设备。（2）其次，考虑自身免疫性疾病患者的自体 HSCT。（3）引入同种异体移植，最初使用强度降低的调理方案。门诊进行 HSCT 更便宜、更安全。（4）不要建造 HEPA 过滤室或层流舱。（5）不要移植脐带血细胞，也不要启动脐带血库。（6）开展更可行且更具成本效益的单倍体同种异体移植。（7）匹配的无关供体非常昂贵。（8）使用仿制药和生物类似药。（9）血液制品辐照设备不是必需的。（10）不要试图复制 HIC 中的其他 HSCT 方案；开发自己的方法。
在 LMIC 中可以以较低的成本和相似的疗效进行 HSCT，从而使更多的人能够负担得起这种治疗选择。
