Jaimovich Gregorio, Lazarus Hillard M, Gale Robert Peter
Department of Bone Marrow Transplantation, Favaloro University Hospital, Buenos Aires, Argentina.
Department of Medicine, Division of Hematology and Oncology, Case Western Reserve University, Cleveland, OH, USA.
Expert Rev Hematol. 2023 Mar;16(3):163-169. doi: 10.1080/17474086.2023.2191946. Epub 2023 Mar 21.
Numbers of hematopoietic cell transplants continue to increase globally but most of this activity is in resource-rich countries. Limitations to increasing transplant activity in resource-poor countries include lack of sophisticated personnel and infrastructure, complexity in identifying and accessing donors, unavailability of some new drugs and high cost.
We searched the biomedical literature for hematopoietic cell transplants and resource-rich and resource-poor countries. Recent advances which potentially make transplants more accessible in resource-poor countries include: (1) outpatient transplants; (2) grafts stored at 4°C; (3) less intensive pretransplant conditioning; (4) use of generic drugs; (5) less complex and costly donor access; and (6) increased collaboration with transplant centers in resource-rich countries.
We reviewed publications on the limitations and solutions discussed above. Paradoxically, most data we analyzed originate from resource-rich countries. We found no convincing epidemiological data to support a recent increased transplant rate in resource-poor countries yet but hope to see increases soon.
全球范围内造血细胞移植的数量持续增加，但大部分此类活动都集中在资源丰富的国家。资源匮乏国家增加移植活动的限制包括缺乏专业人员和基础设施、识别和获取供体的复杂性、一些新药的不可用性以及高成本。
我们检索了生物医学文献中关于造血细胞移植以及资源丰富和资源匮乏国家的内容。近期可能使资源匮乏国家更容易进行移植的进展包括：（1）门诊移植；（2）在4°C储存的移植物；（3）强度较低的移植前预处理；（4）使用通用药物；（5）供体获取过程不那么复杂且成本更低；（6）与资源丰富国家的移植中心加强合作。
我们回顾了关于上述限制和解决方案的出版物。矛盾的是，我们分析的大多数数据都来自资源丰富的国家。我们尚未找到令人信服的流行病学数据来支持资源匮乏国家近期移植率的上升，但希望很快能看到上升趋势。
