Comparison of Steady-State Bone Marrow and GCSF-Primed Stem Cell Sources Used in Allogeneic Hematopoietic Stem Cell Transplantation.

OBJECTIVE: To compare donor graft characteristics and clinical outcomes in recipients of allogeneic heamatopoietic stem cell transplantation (HSCT) using GCSF primed bone marrow (GBM) and steady-state bone marrow (SBM) as stem cell sources. STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Clinical Haematology, Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan, from August 2018 to October 2020. METHODOLOGY: Eighty patients undergoing allogeneic HSCT were analysed. Among these, forty each received GBM and SBM from HLA identical siblings. Graft characteristics, such as total nucleated cells, CD34+ cell yield; clinical outcomes such as neutrophil and platelet engraftment, primary and secondary graft failure (GF), as well as the frequency of acute and chronic graft versus host disease (GvHD), were recorded and compared using the t-test, with significance at p <0.05. RESULTS: A statistically significant difference was observed in CD34+ dose with median dose 7.68 (p=0.002) but not in TNC dose with meadin dose 5 (p=0.86). Neutrophil engraftment occurred much more quickly with median of 13.43 days in the GBM than SBM group (p=0.025). While no statistically significant difference (p=0.89) in platelet engraftment was reported in both SBM and GBM. At the same time, patients with both GBM and SBM transplants showed a comparable ratio of acute to chronic GvHD and primary to secondary GF. CONCLUSION: GBM is associated with better CD34+ stem cell yield and quicker neutrophil engraftment in clinical outcomes. KEY WORDS: Granulocyte colony-stimulating factor, Bone marrow, Hematopoietic stem cell transplantation.

Haematopoietic Stem Cell Transplant Trends in Pakistan: Activity Survey from Pakistan Bone Marrow Transplant Group.

Pakistan is the fifth most populous country with a population of 225 million and has health expenditure accounting for only 2.8 percent of gross domestic product (GDP). Accordingly, there are a limited number of haematology-oncology and transplant centers in the country. The Pakistan Blood and Marrow Transplant (PBMT) group was established in 2020, and this report is the first activity survey from January 2021 to December 2022 focusing on the trends of matched-related donor, haploidentical, and autologous transplants in a developing country. A total of 12 transplant centers contributed data on the modified PBMT survey form retrospectively and 806 haematopoietic stem cell transplants (HSCTs) were carried out during the study duration. Allogeneic HSCT constituted 595 (73.8%) of all the transplants; this is in stark contrast to Western data, where autologous HSCT accounts for the majority of transplants. ß-thalassemia major and aplastic anemia were the commonest indications for allogeneic HSCT, in contrast to Western data, where acute leukemia is the leading transplant indication. Autologous transplants were more frequently performed for Hodgkin's lymphoma as compared to non-Hodgkin's lymphoma and multiple myeloma. The use of peripheral and bone marrow stem cells was comparable. A myeloablative conditioning regimen was routinely used in patients with acute leukemia. This report provides an insight of HSCT trends in Pakistan which are different from those of Western centers contributing to transplant data from South Asia.

Prevalence of Dyslipidemia in Ischemic Stroke Patients: A Single-Center Prospective Study From Pakistan.

Background Stroke is a debilitating condition that adds morbidity to the patient and is an economic burden to society. Several modifiable risk factors can be identified and controlled, and dyslipidemia is one such under-diagnosed and least reported risk factor in Pakistan. We aimed to conduct this study to determine the frequency of dyslipidemia in ischemic stroke patients. Methodology We conducted a prospective cross-sectional study for seven months at Shalamar Hospital, Lahore, from November 2020 to May 2021. One hundred four patients were enrolled as per inclusion and exclusion criteria. After informed consent, a blood sample was taken from the patients and sent to a laboratory to determine dyslipidemia. Demographic details, history, and co-morbidities were also noted on a performa. All the collected data were analyzed in SPSS 20.0. Results The mean age was 53.09 ± 12.51 years. Of 104 patients, 60 (57.69%) were male, and 44 (42.31%) were females, with a male-to-female ratio of 1.4:1. The mean duration of disease in our study was 5.77 ± 3.33 hours. The mean BMI was 27.54 ± 3.03 kg/m2. In our study, the frequency of dyslipidemia in ischemic stroke patients was 39.42% (41 patients).  Conclusion This study concluded that dyslipidemia in ischemic stroke patients is very high in the Pakistani population. This highlighted the need to control this modifiable risk factor in the population. Strategic measures, including pharmacological therapy and diet modification, should be adopted, and awareness about the disease burden, control, and importance should be spread.