Hematopoietic Stem-Cell Transplantation in the Resource-Limited Setting: Establishing the First Bone Marrow Transplantation Unit in Bangladesh

Abstract

Purpose: Treatment of malignant and nonmalignant hematologic diseases with hematopoietic stem-cell transplantation (HSCT) was first described almost 60 years ago, and its use has expanded significantly over the last 20 years. Whereas HSCT has become the standard of care for many patients in developed countries, the significant economic investment, infrastructure, and health care provider training that are required to provide such a service have prohibited it from being widely adopted, particularly in developing countries.

Methods: Over the past two decades, however, efforts to bring HSCT to the developing world have increased, and several institutions have described their efforts to establish such a program. We aim to provide an overview of the current challenges and applications of HSCT in developing countries as well as to describe our experience in developing an HSCT program at Dhaka Medical College and Hospital in Bangladesh via a partnership with health care providers at Massachusetts General Hospital.

Results and conclusion: We discuss key steps of the program, including the formation of a collaborative partnership, infrastructure development, human resource capacity building, and financial considerations.

Fig 1

Human development index and government expenditure in countries with transplantation programs. (A) Countries with capacity for hematopoietic stem-cell transplantation (HSCT) versus human development index. Units for the human development index are squared. Data were derived from the United Nations Development Program. (B) Countries with capacity for HSCT versus government expenditure on health care per capita. Units for health care per capital are provided as square roots. Data were derived from The World Bank. The star marks the position of Bangladesh in 2013 for these two parameters. Countries with transplantation programs were derived from Gratwohl et al.

Fig 2

Development timeline. A highlight of key events for the Dhaka Medical College and Hospital (DMCH) transplantation program is shown, from conception in 2011 until the first autologous transplantation on March 10, 2014. HSCT, hematopoietic stem-cell transplantation; MGH, Massachusetts General Hospital.