Allogeneic bone marrow transplantation in the developing world: experience from a center in India.
We describe our experience of setting up an allogeneic BMT program at the Christian Medical College Hospital, Vellore over a period of 13 years, from October 1986 to December 1999. Two hundred and twenty-one transplants were performed during this period in 214 patients, with seven patients undergoing second transplants. Indication for BMT were thalassemia major - 106 (48%), CML - 30, AML - 35, ALL - 10, SAA - 22, MDS - six and six for other miscellaneous disorders. The mean age of this patient cohort was 15.6 years (range 2-52). Graft-versus-host disease of grades III and IV was seen in 36 patients (17%) and this was the primary cause of death in 20 patients (9.2%). All patients and donors were CMV IgG positive. Sepsis was the primary cause of death in 16 patients (7.4%), 10 bacterial, four fungal and two viral. One hundred and ten of this series of patients are alive and disease free (50%) with a median follow-up of 24 months (range 2-116). These results are comparable to those achieved for patients with similar disease status in transplant units in the Western world and cost a mean of US$15 000.
Chandy
M
M
Department of Hematology, Christian Medical College Hospital, Vellore, India.
Srivastava
A
A
Dennison
D
D
Mathews
V
V
George
B
B
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003906:Developing Countries; D004359:Drug Therapy, Combination; D005260:Female; D006402:Hematologic Diseases / Q000191:economics / Q000401:mortality / Q000628:therapy; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012041:Regional Medical Programs / Q000191:economics / Q000592:standards*; D016019:Survival Analysis; D014184:Transplantation, Homologous / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data*; D016896:Treatment Outcome