Trends of non-communicable diseases and public health concerns of the people of northeastern Nigeria amidst the Boko Haram insurgency
ConclusionThese increasing trends are evidences of the effect of Boko Haram on the public health of the people of northeastern Nigeria and will continue to be a public health concern for the region and the country as a whole.
Fanconi anemia (FA) is a rare genetic disorder characterized by defective cellular DNA repair, associated developmental abnormalities, progressive bone marrow failure (BMF), and a predisposition to hematologic malignancies and solid tumors. 80% of FA patients develop BMF due to progressive depletion of their BM stem cells. Although allogeneic HSCT is a curative treatment for BMF, its utilization and efficacy is limited by availability of donors, risk of GVHD and transplant-related toxicities. Pre-clinical studies showed that ex-vivo insertion of a functional FANCA gene into autologous FA-A CD34+ HSPCs provides a survival a...
Nepal is a low income country in Asia with 38M inhabitants. In August 2016 a Blood&Marrow Transplant (BMT) Center was opened at Civil Service Hospital in Kathmandu initially performing autologous HSCT and since August 2017 also allogeneic HSCT. University of Illinois at Chicago (UIC) has been collaborating with Civil Hospital since 2012 to provide training for staff, advice on infrastructure and stem cell lab operations, clinical protocols, and implementation of a quality program. Until September 2019, a total of 46 HSCT were performed for patients (29 males and 17 females) with hematologic malignancies or aplastic anemia.
Severe aplastic anemia is a life-threatening disease usually treated with immunosuppression or HSCT. This is a multicenter retrospective study that included 78 patients who have undergone haploidentical HSCT with PTCy for severe aplastic anemia in Brazil between 2010 and 2019. Median age was 14 y/o (range: 1-69), and most patients had been heavily transfused. Conditioning regimen was FluCyTBI-based, and GVHD prophylaxis consisted of PTCy, MMF, and tacrolimus (13%) or cyclosporine (87%). Most grafts (92%) were bone marrow.
Allogeneic HCT is a potentially curative strategy for SAA. In combination with fludaribine, anti-thymocyte globulin (ATG) or alemtuzumab, low-dose (2 Gy) total body irradiation (TBI) has been incorporated in the conditioning regimen for matched unrelated donors (MUD) for SAA, with the intention of reducing the cyclophosphamide dose and rate of graft failure. Progressive telomeric shortening in SAA can theoretically increase the risk of radiation injury in affected patients. Outcomes between TBI and non-TBI containing conditioning regimens in SAA have not been systematically compared.
In children with severe acquired aplastic anemia, although matched sibling donor (MSD) hematopoietic stem cell transplant (HSCT) is standard of care. If it's not available then usually immune suppressive therapy (IST) is offered. But the success of IST at best is 50-70% and many children only achieve partial response and still have risk of developing clonal disorders or relapse in follow up. Recent data has shown upfront matched unrelated donor (MUD) HSCT can be as good an option as MSD. However, MUD is not easily available in the developing world due to lack of registries and Non-Caucasian population and multiple ethnicities.
In this study, we retrospectively describe the outcome of nine pediatric patients who underwent haplo-SCT using only PBSC.
Aplastic anemia is characterized by diminished or absent hematopoietic precursors in the bone marrow, most often due to injury to the pluripotent stem cell. In Pakistan, Aplastic Anemia is not uncommon and allogeneic hematopoietic stem cell transplant remains the only curative option in these patients.
Our previous study showed that a less toxic regimen comprising reduced cyclophosphamide (Cy), fludarabine and anti-thymocyte globulin (ATG) (Cy-Flu-ATG), was less toxic for allogeneic hematopoietic cell transplantation (alloHCT) compared with standard Cy-ATG in patients with adult severe aplastic anemia (AA). We postulated that replacing Cy with Flu (Flu-ATG) would be more beneficial. Therefore, we performed a randomized phase III study to compare the regimen-related toxicities (RRTs) of two different conditioning regimens: Cy-ATG vs.
Genetic abnormalities can predispose patients to develop acute myeloid leukemia (AML), aplastic anemia (AA) and myelodysplastic syndrome (MDS). These mutations are more often seen in pediatric patients so genetic screening is more routinely performed in that population. Recent algorithms propose screening in adolescent and young adults (AYAs) with AML/AA/MDS. However, this is not routine practice in community hospitals where most AYAs are treated. Discovery of familial genetic abnormalities can impact donor choice in patients undergoing allogeneic stem cell transplant and treatment/screening in family members.
Transplant-associated thrombotic microangiopathy (TA-TMA) is a rare, potentially lethal complication of allogeneic stem cell transplant. It is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal dysfunction. Endothelial injury and terminal complement activation contribute to the pathogenesis of TA-TMA. Several risk factors have been identified including certain conditioning regimens, acute graft versus host disease (GvHD) and/or calcineurin inhibitors (CNI), and viral infections.