17 Dec

Both from an ethical and sustainability perspective, centers initiating allogeneic transplantation should start with cases least likely to develop severe transplant-related complications. In countries with a population in the 2-5 million range, e.g. Armenia, having an allogeneic transplantation program is justified but the availability of appropriate start-up candidates at low transplant risk may be limited. On the other hand, children with severe sickle cell disease (SCD) have one of the highest success rates after BMT (Iqbal et al. TCT 2020) and may have very poor quality of life and life expectancy (Nnodu et al. Lancet Haematol 2021). Free buccal swab DNA-based HLA typing was offered to families of children with SCD living in Sub-Saharan Africa (thanks to DKMS) and the implications of BMT thoroughly explained. The Cure2Childen Foundation which has been involved in the start up of 10BMT units across the Indian subcontinent and the Middle East, is physically present during start up (Faulkner et al. BMT. 2021). A total of 4 children aged 1.9 to 10.6 years, three from Nigeria and one from Cameroon, were offered free HCT at the Hematology center after prof. R.H.Yeolyan, Yerevan – Armenia equipped with a state-of-the-art HCT unit used for autologous HCT in adults, and an active paediatric hematology-oncology unit treating high-risk patients with intensive chemotherapy. Families were fully informed that their child would be the initial allo HCT patient of that center but also that he/she would be followed by highly experienced HCT specialists.

This limited experience suggests that within structured cooperation with experienced professionals and organizations, offering BMT to children with SCD may facilitate BMT start-up and create a win-win situation for families whom otherwise would have not had the opportunity to cure their children from a life-threatening disease.

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