Research

Single-centre experience of allogeneic haemopoietic stem cell transplant in paediatric patients in Cape Town, South Africa

A van Eyssen, N Novitsky, P de Wit, T Schlaphoff, V Thomas, D Pillay, M Hendricks, A Davidson

Abstract


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.


Authors' affiliations

A van Eyssen, Haematology Oncology Service, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

N Novitsky, Division of Haematology/Bone Marrow Transplantation Service, Department of Medicine, Groote Schuur Hospital, University of Cape Town Private Academic Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

P de Wit, Division of Haematology/Bone Marrow Transplantation Service, Department of Medicine, Groote Schuur Hospital, University of Cape Town Private Academic Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

T Schlaphoff, South African Bone Marrow Registry, Cape Town, South Africa

V Thomas, Division of Haematology/Bone Marrow Transplantation Service, Department of Medicine, Groote Schuur Hospital, University of Cape Town Private Academic Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

D Pillay, Division of Haematology/Bone Marrow Transplantation Service, Department of Medicine, Groote Schuur Hospital, University of Cape Town Private Academic Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

M Hendricks, Haematology Oncology Service, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

A Davidson, Haematology Oncology Service, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

Full Text

PDF (190KB)

Keywords

Allogeneic haematopoietic stem cell transplant; Children; Survival; Outcome

Cite this article

South African Medical Journal 2017;107(3):232-238. DOI:10.7196/SAMJ.2017.v107i3.11313

Article History

Date submitted: 2017-02-27
Date published: 2017-02-27

Article Views

Abstract views: 752
Full text views: 354

Comments on this article

*Read our policy for posting comments here