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13 March 2019

Message to WMDA

Dear International Colleagues

All the best for your Conference 19-21 March and celebration of World Marrow Donor Day 21 September The past few years have seen unprecedented change in the field of transplantation with registries moving to high resolution typing, the rapid growth of Haploidentical transplantation and most recently the prospect of broad access to CAR-t immunotherapies.

The broad use of NGS technology for better typing of registry donors has streamlined the donor search process and reduced delays in donor acquisition and time to transplant. This has even facilitated the rapid decision making of choosing a Haploidentical donor where no MUD is available. Registry donors remain vital to the transplant program as the first alternative to a matched related donor and options to finesse the ABO and CMV status keep them relevant.

CAR-T cell therapies are the new “fashion” and they have naturally found a home in the transplant environment. They remain plagued by extremely high costs and regulatory issues. Nonetheless, their high efficacy will I believe support their momentum and the structured environment of transplant centers will continue to give them a natural home from which patients can access them.

The lack of facilities, trained personnel and access to supportive drugs continue hamper access to curative transplants in resource limited countries. With this in mind, SASCETS has embarked on a project with the CIBMTR to bring South African transplant centers through a process of activity reporting, standardization and ultimately accreditation. We believe that this will facilitate appropriate patient and donor choices and improve access to supportive care. By self-regulation we intend to set standards that health regulatory authorities will be compelled to meet.

Furthermore, we are actively engaged with the South African Department of Health through our Working Parties and patient advocacy groups to find ways to constructively engage the NHI program and broaden access to South African patients.

Stem Cell Transplantation lends itself to curative outcomes and frees patients from chronic illness and relapse. Although expensive at the outset, it is often less expensive and more effective than many other therapies. Thus in resource poor settings it should be used more not less. SASCETS has a good association with the AFBMT society and we would like to develop this further and collaborate to expand our goals where they are shared.

It is time to Get Africa Working!

David Brittain