Pediatric hematopoietic stem cell transplant program in resource-constrained setting: overcoming the challenges

Objective
To elaborate on the steps taken to overcome the challenges in establishing pediatric hematopoietic stem cell transplant program in resource-constrained settings in a government institutions and share the preliminary data of patients who underwent stem cell transplant at the center.


Patients and methods
The pediatric hematopoietic stem cell transplant program was started in the year 2020 with autologous transplants for solid tumors. Allogeneic matched sibling transplant was started in 2023. Data of all the patients who underwent transplants from March 2020 to March 2024 over 4 years was analyzed for clinical profile, transplant-related complications, and outcome.


Results
Twenty patients, aged 1–13 years, included 17 autologous and three matched sibling donor allogeneic stem cell transplants. Indications: Hodgkin lymphoma (seven), neuroblastoma (five), Wilm’s tumor (four), and germ cell tumor (one) for autologous and relapsed acute lymphoblastic leukemia (three) for allogeneic transplants. Peripheral blood stem cells were used in all patients. Sixteen patients developed periengraftment fever. None had culture-proven infection. The median time for neutrophil and platelet engraftment was 11 days (range, 10–14 days) and 14 days (range, 12–16 days), respectively. Four patients with neuroblastoma and one patient with acute lymphoblastic leukemia relapsed posttransplant. At median (interquartile range) follow-up of 392 (105–1613) days, three of relapsed patients died. The overall survival at a median follow-up of 392 days was 85% (n=17). The relapse and nonrelapse mortality was nil at day 30 and day 100.


Conclusion
Establishing a successful and viable pediatric stem cell transplant program is feasible in resource-constrained settings with adaptive measures.