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

South African Medical Journal, Volume 107, No. 3, Year 2017

Interpretation

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 highincome 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.

AI Digest

Study Justification:

– Allogeneic haemopoietic stem cell transplant (Allo-HSCT) is a specialized and costly intervention used to treat a broad range of pediatric conditions.
– South Africa is an upper middle-income country with limitations on healthcare spending.
– The role of pediatric Allo-HSCT in this setting needs to be reviewed to assess its feasibility and outcomes.

Study Highlights:

– A total of 48 children received Allo-HSCT at the Groote Schuur Hospital/University of Cape Town Private Academic Hospital transplant unit in Cape Town, South Africa, between January 2006 and December 2014.
– The transplant indications included haematological malignancies, non-oncological haematological conditions, immune disorders, and adrenoleukodystrophy.
– The majority of transplants used sibling matched peripheral-blood stem cells (PBSC), while some used unrelated donor grafts or umbilical cord blood.
– Overall survival (OS) rates were excellent for non-oncological conditions (91.3%) and comparable to high-income settings for oncological disorders (56.8%).
– Some survivors developed chronic graft-versus-host disease.

Study Recommendations:

– Allo-HSCT is a feasible and rewarding treatment option for pediatric patients in a less well-resourced environment.
– Further research is needed to improve outcomes for oncological disorders and reduce the risk of graft-versus-host disease.
– Collaboration with international registries for unrelated donor grafts and umbilical cord blood can expand donor options.
– Continued investment in healthcare infrastructure and resources is necessary to support the implementation and sustainability of Allo-HSCT programs.

Key Role Players:

– Pediatric transplant unit at Groote Schuur Hospital/University of Cape Town Private Academic Hospital
– Red Cross War Memorial Children’s Hospital for post-transplant care
– Donors and donor registries for unrelated donor grafts and umbilical cord blood
– Healthcare professionals including hematologists, transplant physicians, nurses, and support staff
– Researchers and data analysts for ongoing monitoring and evaluation

Cost Items for Planning Recommendations:

– Healthcare infrastructure and facilities
– Medical equipment and supplies
– Personnel salaries and training
– Donor registry collaboration and fees
– Research and data analysis funding
– Patient support services and follow-up care
– Public awareness and education campaigns

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides a retrospective analysis of patient records and includes relevant demographic, clinical, and laboratory data. However, the sample size is relatively small (48 children) and the follow-up period varies among patients. To improve the strength of the evidence, the study could benefit from a larger sample size and a longer follow-up period to provide more robust conclusions. Additionally, including a comparison group from a similar setting or a randomized controlled trial would further enhance the evidence.

Abstract

Materials

N/A

Innovations

I’m sorry, but I’m not able to provide specific innovations for improving access to maternal health based on the information you provided. Can you please provide more context or specific details about the challenges or areas of improvement you would like to address?

AI Innovations Description

The provided description focuses on a study conducted on allogeneic haemopoietic stem cell transplant (Allo-HSCT) in paediatric patients in Cape Town, South Africa. The study aimed to review the patients who underwent Allo-HSCT and assess the indications for the transplant, donor sources, conditioning regimens, treatment-related morbidity, and overall survival (OS). Here are some recommendations that can be used to develop innovations to improve access to maternal health:

1. Increase awareness and education: Develop educational programs and campaigns to raise awareness about the importance of maternal health and the available healthcare services. This can be done through community outreach programs, workshops, and partnerships with local organizations.

2. Strengthen healthcare infrastructure: Invest in improving healthcare facilities, equipment, and resources to ensure that maternal health services are readily available and accessible to all women. This includes establishing well-equipped maternity clinics, hospitals, and birthing centers in areas with limited access to healthcare.

3. Enhance transportation services: Develop transportation systems or partnerships to provide reliable and affordable transportation for pregnant women to reach healthcare facilities. This can include initiatives such as community-based transportation services, mobile clinics, or telemedicine options for remote consultations.

4. Improve antenatal and postnatal care: Enhance the quality and availability of antenatal and postnatal care services, including regular check-ups, screenings, and counseling for pregnant women. This can help identify and address any potential complications or risks early on, leading to better maternal and neonatal outcomes.

5. Strengthen healthcare workforce: Invest in training and capacity building for healthcare professionals, particularly in underserved areas, to ensure that there are enough skilled personnel to provide quality maternal healthcare services. This can include training midwives, nurses, and doctors in obstetric care and providing incentives for healthcare professionals to work in remote or rural areas.

6. Promote community engagement: Encourage community involvement and participation in maternal health initiatives. This can be done through the establishment of community health committees, support groups, and partnerships with local leaders and organizations. Engaging the community can help address cultural barriers, increase trust in healthcare services, and promote positive health-seeking behaviors.

By implementing these recommendations, it is possible to improve access to maternal health services, reduce maternal mortality rates, and enhance overall maternal and neonatal outcomes.

AI Innovations Methodology

Based on the provided description, it seems that the request for innovations to improve access to maternal health is not directly related to the content. However, I can provide a general methodology to simulate the impact of recommendations on improving access to maternal health.

Methodology to Simulate the Impact of Recommendations on Improving Access to Maternal Health:

1. Define the objectives: Clearly define the specific objectives of the simulation study, such as assessing the impact of different interventions on improving access to maternal health.

2. Identify key variables: Identify the key variables that affect access to maternal health, such as availability of healthcare facilities, healthcare workforce, transportation, financial resources, and cultural factors.

3. Collect data: Gather relevant data on the identified variables from reliable sources, such as government reports, surveys, and existing research studies. This data will serve as the basis for the simulation model.

4. Develop a simulation model: Use a suitable simulation modeling technique, such as system dynamics or agent-based modeling, to develop a simulation model that represents the complex interactions and dynamics of the maternal health system.

5. Define scenarios: Define different scenarios that represent potential recommendations or interventions to improve access to maternal health. For example, scenarios could include increasing the number of healthcare facilities, training more healthcare professionals, implementing transportation systems, or providing financial support for maternal healthcare.

6. Implement scenarios: Incorporate the defined scenarios into the simulation model and simulate the impact of each scenario on access to maternal health. This can be done by adjusting the relevant variables in the model based on the recommendations being simulated.

7. Analyze results: Analyze the simulation results to assess the impact of each scenario on improving access to maternal health. Evaluate key performance indicators, such as the number of women accessing maternal healthcare services, reduction in maternal mortality rates, and improvement in healthcare outcomes.

8. Validate and refine the model: Validate the simulation model by comparing the simulated results with real-world data or expert opinions. Refine the model based on feedback and make necessary adjustments to improve its accuracy and reliability.

9. Communicate findings: Present the findings of the simulation study in a clear and concise manner, highlighting the potential impact of the recommended interventions on improving access to maternal health. This information can be used to inform policy decisions and guide resource allocation for maternal healthcare.

It’s important to note that the specific details and complexity of the simulation methodology may vary depending on the scope and objectives of the study.

Author


Dima Health

Statistics:

Citations: 4

Identifiers:

DOI: 10.7196/SAMJ.2017.v107i3.11313

ISSN: 02569574

Research Areas:

Cancer, Community Interventions, Health System and Policy, Maternal and Child Health, Social Determinants

Study Countries:

South Africa

Study Design:

Cohort Study, Cross Sectional Study, randomised-control-trial

Participants Gender:

Male & Female