This is the first study to collectively report the HCT situation in Saudi Arabia over the past five years (2018-2022). This data represents transplant activity at the national level in KSA. We discuss the progress and future directions of his HCT since the beginning of the transplant program.
The results show that the growth in the number of HCT transplants per 10 million inhabitants has accelerated over the past 30 years since the inception of the HCT program, and is at the highest level in the Central Region. The majority of centers are located in the central region, where the highest number of HCTs are reported. However, more centers are needed based on the ratio of hospital beds to population in each region, as reported in a study presented at KSA 2022. This is consistent with the distribution of hospital beds in the general population, as reported in the study presented at KSA 2022. From 2015 to 2019, the total number of hospital beds in the general population increased from 3,469 per 1,576,070 population to 3,849 per 1,710,908 population. In total, the number of hospital beds increased from 237 (2015) to 246.8 (2019). [12]. The results of the HCT Activity Survey showed that HCT rates are increasing year-on-year, consistent with the global increase in the number of HCTs. (united states of america) [13],Europe [14],China [15]. There are several possible reasons for this global increase in HCT. (i) advances in HCT methods and techniques; (ii) advances in conditioning therapy; and (iii) changes in disease indications.Consider non-malignant disease and early stage malignant disease [15](iv) inclusion of more types of donors; The increase in the number of facilities performing HCT since 1984 from one facility to eight as of 2022 is also due to the rapid increase in healthcare spending in Saudi Arabia since 2011. doing. [16].
A survey of HCT activity in Saudi Arabia shows that both autologous and allogeneic HCT are increasing over time, but the proportion of allogeneic is higher than autologous HCT. It has also been reported that in China, the proportion of allogeneic strains is higher than that of autologous strains. [15] and in the Eastern Mediterranean region [17]. Conversely, according to 2018 US transplant activity, autologous HCT was higher in adults (65%). [18]Similarly, higher autologous HCT was reported by EBMT. [14]. A potential basis for the higher rate of allogeneic HCT compared to autologous HCT in both adult and pediatric age groups in Saudi Arabia is the chance of finding a matched sibling donor. Consanguinity helps you obtain matched, related, and identical donors.Adults in Saudi Arabia are more likely to find a matched sibling donor (68%) due to larger family size [19].
The 5-year HCT numbers in our study differ from those reported by EBMT. One possible reason for her low number of HCTs in the EBMT data is that only 75% of her respondents reported a contribution to EBMT. One local registry, SBMTR, exists, but only a few participants (12%) reported submitting data to SBMTR. The proportion of HCT decreased (15%) in 2020 (coronavirus outbreak) but increased (25%) in 2021.
The most common indications for autologous HCT in the Saudi population were MM, HL, NHL, similar to those reported in China: MM, NHL, acute myeloid leukemia (AML) [15]EBMT: (plasma cell disorder (PCD), NHL, HL) [14]Latin America: PCD, NHL, HL [20].
The most common indications for allogeneic HCT in the Saudi population are hemoglobinopathies, AML, precursor lymphoid tumors, and AML, acute lymphoblastic leukemia (ALL), similar to those reported in China. , and had aplastic anemia (AA). [15]EBMT: AML, ALL, MDS [14]Latin America: AML, ALL, bone marrow failure (BMF) [20].
Indications for allogeneic HCT reported at KSA 2016 were AML (20%), ALL (18%), and chronic myeloid leukemia (CML) (16%). [9]. The current study shows that the indication for allogeneic HCT has switched from CML (16%). [9] Hemoglobinopathies (27.6%) occurred in Saudi Arabia during the past 5 years. A possible explanation is the high prevalence of hemoglobinopathies (sickle cell disease 0.26%) in the eastern region. [21]. KSA has a younger median age for transplant patients [9]This is consistent with the relatively young average age of Saudi citizens (29 years). [22].
CAR T cell therapy was launched in 2019. CAR T-cell therapy is currently reported to be working in three centers with indications for ALL and lymphoma. Other centers have also started the process and are expected to be listed soon. This will likely lead to a decrease in HCT rates and an increase in his CAR T cell therapy in the coming years. Currently, three products are used in his three centers: Cilta-cel, Tisa-cel and Axi-cel. In-house production of CART cells is also continuing.
Kingdom of Saudi Arabia Registry
There are two donor registries. Saudi Stem Cell Donor Registry (SSCDR) and King Faisal Specialist Hospital & Research Center Donor Registry (KFSH&RC DR), and two cord blood banks. KAIMRC CBB and KFSH&RC CBB. Currently, HCT centers submit data to international registries. However, one registry to collect HCT data locally, the Saudi Bone Marrow Transplant Registry (SBMTR), has been established since 2015.
Limitations
HCT cases are a mix of cases and do not accurately represent the region of origin. Subjects from one region have undergone transplantation or reside in another region. Results and donor data were not obtained. Finally, data heterogeneity due to the lack of a single data collection source remains a challenge.
