Single-centre experience of allogeneic haemopoietic stem cell transplant in paediatric patients in Cape Town, South Africa
Background. Allogeneic haemopoietic stem cell transplant (Allo-HSCT) is a specialised and costly intervention, associated with significant morbidity and mortality. It is used to treat a broad range of paediatric conditions. South Africa (SA) is an upper middle-income country with limitations on heal...
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| Format: | Article |
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South African Medical Association
2017-03-01
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| Series: | South African Medical Journal |
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| Online Access: | http://www.samj.org.za/index.php/samj/article/view/11843/8002 |
| _version_ | 1797370312103297024 |
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| author | A van Eyssen N Novitsky P de Wit T Schlaphoff V Thomas D Pillay M Hendricks A Davidson |
| author_facet | A van Eyssen N Novitsky P de Wit T Schlaphoff V Thomas D Pillay M Hendricks A Davidson |
| author_sort | A van Eyssen |
| collection | DOAJ |
| description | Background. Allogeneic haemopoietic stem cell transplant (Allo-HSCT) is a specialised and costly intervention, associated with significant morbidity and mortality. It is used to treat a broad range of paediatric conditions. South Africa (SA) is an upper middle-income country with limitations on healthcare spending. The role of paediatric Allo-HSCT in this setting is reviewed.
Objectives. To review paediatric patients who underwent Allo-HSCT at the Groote Schuur Hospital/University of Cape Town Private Academic Hospital transplant unit in Cape Town, South Africa, and received post-transplant care at Red Cross War Memorial Children’s Hospital, over the period January 2006 - December 2014 in respect of indications for the transplant, donor sources, conditioning regimens, treatment-related morbidity and overall survival (OS).
Methods. A retrospective analysis of patient records was performed and a database was created in Microsoft Access. Descriptive analyses of relevant demographic, clinical and laboratory data were performed. Summary statistics of demographic and clinical parameters were derived with Excel. OS was calculated from the date of transplant to the date of an event (death) or last follow-up using the Kaplan-Meier method in Statistica.
Results. A total of 48 children received Allo-HSCT: 24 for haematological malignancies, 20 for non-oncological haematological conditions, 3 for immune disorders and 1 for adrenoleukodystrophy. There were 28 boys (median age 7.5 years) and 20 girls (8.5 years). There were 31 sibling matched peripheral-blood stem cell (PBSC) transplants and 1 maternal haploidentical PBSC transplant. Stem cells were mobilised from bone marrow into peripheral blood by administering granulocyte-colony stimulating factor to donors. PBSCs were harvested by apheresis. Eight patients received 10/10 HLA-matched grafts from unrelated donors. Six were PBSC grafts and 2 were bone marrow grafts. Three of the unrelated PBSC grafts were from SA donors. Eight transplants used umbilical cord blood from international registries. OS for patients with non-oncological disorders was 91.3% (median follow-up 3.9 years), while that for oncology patients was 56.8% (1.9 years). Two of the survivors developed chronic graft-versus-host disease.
Conclusions. OS for non-oncological conditions was excellent, while outcomes for oncological disorders were on par with those in high-income settings. Transplantation offers many patients the opportunity for long-term survival and has been shown to be both feasible and rewarding in a less well-resourced environment servicing an economically diverse population. |
| first_indexed | 2024-03-08T17:59:33Z |
| format | Article |
| id | doaj.art-c9becc0a95724982a527895f5ed09efe |
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| issn | 0256-9574 2078-5135 |
| language | English |
| last_indexed | 2024-03-08T17:59:33Z |
| publishDate | 2017-03-01 |
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| spelling | doaj.art-c9becc0a95724982a527895f5ed09efe2024-01-02T02:36:05ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352017-03-01107323223810.7196/SAMJ.2017.v107i3.11313Single-centre experience of allogeneic haemopoietic stem cell transplant in paediatric patients in Cape Town, South AfricaA van Eyssen0N Novitsky1P de Wit2T Schlaphoff3V Thomas4D Pillay5M Hendricks6A Davidson7 Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South AfricaGroote Schuur Hospital, University of Cape Town Private Academic Hospital and Faculty of Health SciencesGroote Schuur Hospital, University of Cape Town Private Academic Hospital and Faculty of Health SciencesGroote Schuur Hospital, University of Cape Town Private Academic Hospital and Faculty of Health SciencesGroote Schuur Hospital, University of Cape Town Private Academic Hospital and Faculty of Health SciencesGroote Schuur Hospital, University of Cape Town Private Academic Hospital and Faculty of Health Sciences Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South AfricaBackground. Allogeneic haemopoietic stem cell transplant (Allo-HSCT) is a specialised and costly intervention, associated with significant morbidity and mortality. It is used to treat a broad range of paediatric conditions. South Africa (SA) is an upper middle-income country with limitations on healthcare spending. The role of paediatric Allo-HSCT in this setting is reviewed. Objectives. To review paediatric patients who underwent Allo-HSCT at the Groote Schuur Hospital/University of Cape Town Private Academic Hospital transplant unit in Cape Town, South Africa, and received post-transplant care at Red Cross War Memorial Children’s Hospital, over the period January 2006 - December 2014 in respect of indications for the transplant, donor sources, conditioning regimens, treatment-related morbidity and overall survival (OS). Methods. A retrospective analysis of patient records was performed and a database was created in Microsoft Access. Descriptive analyses of relevant demographic, clinical and laboratory data were performed. Summary statistics of demographic and clinical parameters were derived with Excel. OS was calculated from the date of transplant to the date of an event (death) or last follow-up using the Kaplan-Meier method in Statistica. Results. A total of 48 children received Allo-HSCT: 24 for haematological malignancies, 20 for non-oncological haematological conditions, 3 for immune disorders and 1 for adrenoleukodystrophy. There were 28 boys (median age 7.5 years) and 20 girls (8.5 years). There were 31 sibling matched peripheral-blood stem cell (PBSC) transplants and 1 maternal haploidentical PBSC transplant. Stem cells were mobilised from bone marrow into peripheral blood by administering granulocyte-colony stimulating factor to donors. PBSCs were harvested by apheresis. Eight patients received 10/10 HLA-matched grafts from unrelated donors. Six were PBSC grafts and 2 were bone marrow grafts. Three of the unrelated PBSC grafts were from SA donors. Eight transplants used umbilical cord blood from international registries. OS for patients with non-oncological disorders was 91.3% (median follow-up 3.9 years), while that for oncology patients was 56.8% (1.9 years). Two of the survivors developed chronic graft-versus-host disease. Conclusions. OS for non-oncological conditions was excellent, while outcomes for oncological disorders were on par with those in high-income settings. Transplantation offers many patients the opportunity for long-term survival and has been shown to be both feasible and rewarding in a less well-resourced environment servicing an economically diverse population.http://www.samj.org.za/index.php/samj/article/view/11843/8002Allogeneic haematopoietic stem cell transplantChildrenSurvivalOutcome |
| spellingShingle | A van Eyssen N Novitsky P de Wit T Schlaphoff V Thomas D Pillay M Hendricks A Davidson Single-centre experience of allogeneic haemopoietic stem cell transplant in paediatric patients in Cape Town, South Africa South African Medical Journal Allogeneic haematopoietic stem cell transplant Children Survival Outcome |
| title | Single-centre experience of allogeneic haemopoietic stem cell transplant in paediatric patients in Cape Town, South Africa |
| title_full | Single-centre experience of allogeneic haemopoietic stem cell transplant in paediatric patients in Cape Town, South Africa |
| title_fullStr | Single-centre experience of allogeneic haemopoietic stem cell transplant in paediatric patients in Cape Town, South Africa |
| title_full_unstemmed | Single-centre experience of allogeneic haemopoietic stem cell transplant in paediatric patients in Cape Town, South Africa |
| title_short | Single-centre experience of allogeneic haemopoietic stem cell transplant in paediatric patients in Cape Town, South Africa |
| title_sort | single centre experience of allogeneic haemopoietic stem cell transplant in paediatric patients in cape town south africa |
| topic | Allogeneic haematopoietic stem cell transplant Children Survival Outcome |
| url | http://www.samj.org.za/index.php/samj/article/view/11843/8002 |
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