Abeysinghe P, Morawaka L, Gunasekara S, Suresh S, Jayathilake Pwdcc, Udara Phsp, Siriwardena Ppr, Milliken S, Moore J, Ma Ddf
National Cancer Institute, Sri Lanka.
National Blood Transfusion Service, Sri Lanka.
Blood Cell Ther. 2019 Nov 25;2(4):50-53. doi: 10.31547/bct-2019-007.
Sri Lanka is a developing country with a population of 21 million. Nation Cancer Institute (NCI) is the largest tertiary cancer centre with universal health coverage. Absence of hematopoietic stem cell transplant (HSCT) was a major deficiency as most patients cannot afford transplant abroad. In 2013-14, NCI decided to establish the first National HSCT center in collaboration with St. Vincent's Hospital Sydney. Eventually, the first Autologous HSCT was established at NCI in December 2016. Patients with multiple myeloma (MM) in very good partial remission or better remission, and patients with relapsed Non-Hodgkin's lymphoma (NHL) and Hodgkin lymphoma (HL), who were less than 65 years with good performance status were selected. Stem cells were mobilized with cyclophosphamide and G-CSF and the products were cryopreserved. Melphalan was the conditioning regime for MM while BEAM was used for HL and NHL. Twenty autologous transplants were performed in the first year. Mean age was 47 years (range: 17-62) and male to female ratio was 3: 2. There were 17 MM and one each of NHL, HL and POEMS syndrome patients. Median CD34＋ stem cells collected was 12.72×10/kg (range: 3-31) and median infused cell dose was 4.07×10/kg (range: 2-7.4). Median engraftment day was 13 (range: 11-19) and median hospitalization was 16 days (range: 14-20). All developed febrile neutropenia and GradeⅢ thrombocytopenia. Zero transplant-related mortality was observed with acceptable morbidity. At the median follow-up of 47 weeks, the overall survival was 100% with all the patients still in remission.
斯里兰卡是一个拥有2100万人口的发展中国家。国家癌症研究所（NCI）是该国最大的提供全民医保的三级癌症中心。由于大多数患者无力承担在国外进行移植的费用，缺乏造血干细胞移植（HSCT）曾是一个重大缺陷。2013 - 2014年，NCI决定与悉尼圣文森特医院合作建立首个国家HSCT中心。最终，2016年12月在NCI成功开展了首例自体HSCT。入选患者为年龄小于65岁、身体状况良好、处于非常好的部分缓解或更好缓解状态的多发性骨髓瘤（MM）患者，以及复发的非霍奇金淋巴瘤（NHL）和霍奇金淋巴瘤（HL）患者。使用环磷酰胺和粒细胞集落刺激因子（G - CSF）动员干细胞，并将采集的干细胞产品进行冷冻保存。美法仑用于MM的预处理方案，而BEAM方案用于HL和NHL。第一年共进行了20例自体移植。平均年龄为47岁（范围：17 - 62岁），男女比例为3∶2。其中有17例MM患者，以及各1例NHL、HL和POEMS综合征患者。采集的CD34＋干细胞中位数为12.72×10/kg（范围：3 - 31），输注的细胞剂量中位数为4.07×10/kg（范围：2 - 7.4）。移植后中性粒细胞植入中位数为13天（范围：11 - 19天），住院时间中位数为16天（范围：14 - 20天）。所有患者均出现发热性中性粒细胞减少和Ⅲ级血小板减少。观察到零移植相关死亡率，且发病率可接受。在中位随访47周时，所有患者仍处于缓解状态，总生存率为100%。
