Demystyfication versus
trivialization of stem cell transplantation [read the
answer
to this letter]
José R. Borbolla, MD*, Mauricio González-Avante,
MD**, Alberto J. Siller, MD***
*Stem Cell Transplant Program, División de Ciencias de
la Salud, Instituto Tecnológico y de Estudios Superiores de
Monterrey, Nuevo León, México; *Hematology Dept.
Hospital General de Zona 32, IMSS, México city; *Stem Cell
Transplant Program, Hospital de Especialidades 25, IMSS,
Monterrey, Nuevo León, México.
Correspondence: Dr. José Rafael Borbolla Escoboza, Centro
de Investigación y Extensión en Ciencias de la
Salud, División de Ciencias de la Salud, Intituto
Tecnológico y de Estudios Superiores de Monterrey. Apartado
5091, Sucursal Tecnológico? Monterrey, Nuevo León
64849 México. Phone/Fax +52 8 3331121 - E-mail:
jrborbol@campus.mty.itesm.mx
We read with great detail and interest Dr. Ruiz´s
editorial,1, and we would like to make two observations
about it: First: although we concur with our respected colleague's
view on both the exciting developments and the need for cheaper
ways to perform stem cell transplants, it is our opinion that the
novel allotransplant approach using non-myelotoxic
immunosuppression (mini-transplant), although certainly cheaper,
is still years away from becoming the treatment of choice for
diseases in which "conventional" myelotoxic conditioning regimens
followed by allotransplant, are currently used. For example, we
believe no one would attempt a mini-transplant on any CML or ANLL
patient with a suitable donor and no contraindications for a
"conventional" allotransplant. And second, while we totally agree
with Dr. Ruiz´s statement that "the carrying out of
modern, intensive, therapeutic procedures on an outpatient basis
is feasible provided that certain requirements are fulfilled",
we believe that these requirements, which usually have to do with
minimum home sanitary conditions, as well as access to expensive
drugs like cytokines, are only available to the minority of people
in developing countries such as ours. As a matter of fact, several
BMT programs in Mexico have had to set up temporary homes for
local patients to stay after their transplant due to their very
poor living conditions. As a group we believe in the need to
"demystify" the transplant procedure, making it available to more
patients. We are currently involved in an effort to promote easier
and cheaper cryopreservation techniques2 which would
allow hematologists, with adequate training, in small and medium
size hospitals, to perform autologous transplants. But we do
believe that oversimplification might lead to this procedure being
undertaken by people without sufficient training.
