Conducting hematopoietic stem cell transplantation in low and middle income countries

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The decalogue of recommendations to start an HSCT program in low and middle income countries^a 1. Start with autologous transplantations in patients with hematological malignancies, specifically multiple myeloma. Cell freezing devices are not necessary. 2. Next, consider patients with autoimmune diseases who are eligible for autologous transplantation 3. Introduce allogeneic transplants, initially using reduced intensity conditioning regimens. Conduct the transplants on an outpatient basis; it 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. Do not buy blood product irradiation devices; they are not necessary 10. Do not reproduce other HSCT programs; develop your own methods. ^aAdapted from reference [1]

Ruiz-Argüelles GJ. Lessons learned starting a bone marrow transplantation programme in a resource-constrained setting. Lancet Haematol. 2020 Jul;7(7):e509–e510. doi:10.1016/S2352-3026(20)30184-8. PMID: 32589976.

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