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EXPERIENCE OF THE NBTC IN THE PREPARATION OF AHSC GRAFT IN TUNISIA PREPARED BY: NADRA GABSI LEILA BEN HAMED F. JENHANI T. BEN OTHMEN S. HMIDA E. GOUIDER M. MAAMER A. SKHIRI H. KAABI N. MOJAAT Slide 2 Historical Overview 1958: Pr. Jean DAUSSET - discovery of the HLA system 1945: The bombings in Hiroshima and Nagasaki 1950s Concept of "stem cell" - First clinical trials (failures) 1968: Robert A. Good -The first successful AHSCT 1980s: Widespread Clinical use of HSCs 1998: The first AHSCT in TUNISIA 2010 : AHSCT the only cure for many hematopoietic disorders.. 2010 Slide 3 OBJECTIVE Slide 4 We report data of the NBTC in the preparation of the graft using manual handling over 12 years Slide 5 MATERIALS Slide 6 Materials February 1998 July 2010 474 patients total. Donors: HLA-identical siblings 53% Males 47% Females Median age: 21 years (Range: 2 62 years) Slide 7 DISEASES 55% 45% ACUTE LEUKEMIA APLASTIC ANEMIA MALIGNANTNON MALIGNANT (41%) (28%) (11%)(17%) Slide 8 SOURCES OF HSCs BONE MARROW PERIPHERAL BLOOD Slide 9 METHODS Slide 10 Major Minor Mixed ReceiverDonor GRAFT PREPARATION ABO- incompatibility Slide 11 Slide 12 Blood cell depletion (Major or mixed ABO-incompatibility) Ficoll density gradient centrifugation Slide 13 Manual blood cell depletion (Major and mixed ABO-incompatibility) Ficoll density gradient centrifugation Slide 14 Manual blood cell depletion (Major and mixed ABO-incompatibility) Ficoll density gradient centrifugation Slide 15 Slide 16 Plasma depletion (Minor ABO-incompatibility) Slide 17 Graft quality LamellaMalassez cell FLOW CYTOMETRY The numeration of mononuclear cells (MNC) The count of CD34+ CFU-GM (Only in the first 7 years) Slide 18 The most crucial step Samples of high quality Sufficient number of HSCs The PREPARATION of the GRAFT SO, Slide 19 RESULTS Slide 20 CELLS MNC ( x 10 8 /Kg) CD34+ ( x 10 6 /Kg) MeanMedian Extreme 2 3.062.6 76% 3.83 3.03 0.23 21.83 71% 0.67 17 Slide 21 Correlation between MNC and CD34+ (Pearson statistical test ) P=0.000 Correlation coefficient=0.406 Slide 22 MinorCompatible Major & mixed 474 CASES TOTAL 3 groups Slide 23 Slide 24 Slide 25 Slide 26 Slide 27 No immediate or delayed hemolysis No infectious events related to graft contamination Slide 28 CONCLUSION Slide 29 The manual handling of the graft slow and laborious procedure Slide 30 conomic barriers afety of patients E S H ematological disorders Slide 31 NCBMT Activity Slide 32 Transition Manual handling 1998-2010 Automatic preparation Slide 33 THANKS Slide 34 ransfusion enter lood ational NBTCTUNISIA Slide 35 ransfusion enter lood ational N B T C TUNISIA Slide 36 ransfusion enter lood ational NBTCTUNISIA Slide 37 ransfusion enter lood ational N B T C TUNISIA Slide 38 ransfusion enter lood ational NBTCTUNISIA Slide 39 ransfusion enter lood ational N B T C TUNISIA Slide 40