Hematopoietic Stem Cell Transplantation in Southern Iran: History, Current Status and Future Direction

Transplantation of hematopoietic stem cells (HSCT) has become the standard treatment for many patients with congenital or acquired disorders of the hematopoietic system or with chemo-radio or immuno-sensitive malignancies. HSCT has undergone rapid expansion over the past two decades. Despite the high cost and the complexity of the procedure, HSCT has developed in developing countries. The transplant program was established in Shiraz University of Medical Sciences in 1993 in Shiraz, southern Iran and is a referral center for about 10 million patients with hematology-oncology diseases. From 1993 to 2009, more than 450 allogeneic and autologous transplantations were undertaken. Since 2003, stem cell sources from the bone marrow have changed to peripheral blood for almost all disease indications. The main indication for HSCT is now the hematologic malignancies instead of hemoglobinopathy (thalassemia major). From 1993 to 2007, HSCT was performed on 155 blood transfusion dependent patients with thalassemia major with disease-free survival and overall survival of 71% and 77%, respectively. During this time, 127 leukemia patients underwent allogeneic HSCT including AML (n=68), ALL (n=30) and CML (n=29). In this group, long term disease-free survival rate (cure rate) was 67%, 60% and 62%, respectively. Even HSCT is rising rapidly in during the five past years; however, when the total transplantation to the total number of population is compared in our region, the rate is still low. It seems that the government should support the therapeutic approaches more in our country and help to overcome the difficulties.