Setting-up a Bone Marrow Transplant Unit in A Resource-Limited Country – Challenges and Learnings

Introduction: Bone marrow transplant (BMT) is an integral part of the management of various blood disorders, but establishing a new transplant unit is a major undertaking.1 Resource constraints in underdeveloped countries like Pakistan compound the process further.2,3 This study reviews the challenges and initial outcomes of our newly established transplant unit. Methodology:The transplant unit's activity over the past 22 months since its inauguration was reviewed.Data was collected from meeting minutes, regulatory approval documents, and patient records. Results:The unit was initially established with a 4-room setup, designed to accommodate up to 40 transplants per year.Each room was equipped with portable HEPA filters, achieving ISO 8-level cleanroom air quality.During the first year, efforts focused on developing SOPs, optimizing conditions for neutropenic patients, establishing a drug formulary, obtaining regulatory approvals, and recruiting trained staff.Admission delays occurred on three occasions due to shortages of trained nurses and chemotherapy drugs.To date, 11 transplants have been performed, with a median follow-up of 7 months and an overall survival (OS) rate of 90.9%.Febrile neutropenia was observed in 81.8% of cases, primarily caused by CV-line infections (n=7).Gut toxicity affected 85.7% of autografts (n=6/7), along with complications such as mucositis, cyclosporine-induced hypertension and toxicity, and platelet refractoriness requiring frequent transfusions.