Introduction of Hematopoietic Stem Cell Transplantation in Mongolia

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1 OYUNDELGER Norov, Prof., KHISHIGJARGAL Batsukh, MD. BMT and Hematology center First Central Hospital of Mongolia Introduction of Hematopoietic Stem Cell Transplantation in Mongolia

2 MONGOLIA

3 MONGOLIA Area: total: 1,5 million km 2 country comparison to the world: 19 Population: 2,9 million (2014 est.) country comparison to the world: 140 Population density: 1.88 person/km 2 country comparison to the world: 1 GDP - per capita (PPP): $3,996 (2013 est.) country comparison to the world: 108

4 MONGOLIA

5 Hematological healthcare service in Mongolia Provided at following 2 hospitals The First Central Hospital - for adult The National Center for Child - for children

6 First Central Hospital of Mongolia Founded in 1925 First Government Hospital in Mongolia 570 beds 710 Staff, including 170 physicians Only one Transplantation Center in Mongolia which performs kidney and liver transplantation First BMT case was performed in 2014

7 Why we need BMT? Blood cancer and other severe hematological disorder rate is increasing annually Current prognoses is poor in Mongolia Those patients who need BMT must travel abroad /high cost/ After returning these transplant patients need follow up check in Mongolia Home treatment is suitable for patients Successful BMT equals development of health care at national level

8 Acute leukemia incidence /adult/ Number of cases diagnosed at First Central Hospital

9 Blood cancer incidence for last 5 year AML ALL MM MPD

10 Statistical profile Age distribution of patients with blood cancer 3% 12% 31% <20 yrs yrs yrs >60 yrs 54%

11 BMT development project Started in 2011 by Prof. Oyundelger. M.D., Funding: Government and FCH BMT development project had 3 main goals: Human resources training Establishment of BMT unit Renovation and purchase of necessary laboratory equipments

12 BMT development project Human resources training: Most of our BMT staff received 1-3 month training at BMT center of Seoul St. Mary s Hospital, The Catholic University of Korea

13 Hematology and BMT Center Total staff 23, including hematologists; laboratory physicians; infectious disease specialist; ICU doctors; nurses and engineers

14 Cooperation parties for BMT Administration of FCH Seoul St.Mary s Hospital Other disciplinary departments BMT Department National Cancer Center National Transfusion Center

15 BMT development project Establishment of clean BMT unit facility. Including: Clean patient room Cell processing room Freezing room Apharesis unit BMT ICU section

16 Patient room

17 BMT Department

18 Patient room

19 Patient room

20 Patient room

21 Nursing station

22 ICU equipments

23 Cell freezing room

24 Apheresis unit

25 Food One of Mongolian BMT feature is specific method of meat processing which fit with mongolian people character.

26 BMT development project Renovation of necessary laboratory equipment included: Molecular Genetics: Real-Time PCR system/ab 7500/ DNA Sequencer /AB 3500/ Fragment analyzer Luminex flow cytometry Immunophenotyping: FACS Canto 2 Special chemistry: Automated capillary electrophoresis system Drug analyzer /Siemens/

27 Immunophenotyping FACS Canto 2

28 Molecular Genetics Luminex flow cytometry

29 Molecular Genetics Real-Time PCR system/ab 7500/ DNA Sequencer /AB 3500/

30 Molecular Genetics Fragment analyzer

31 International cooperation APBMT membership since 2011 BMT center of Seoul St. Mary s Hospital, The Catholic University of Korea China, No. 307 Hospital

32 First BMT Case in Mongolia: First BMT was performed 2014-Feb-27th 51 years old male patient; diagnosed 2013-April Multiple myeloma, LCD k type IIIa CTx 4 cycles of Vdex Аuto PBSCT Patient s current status is good Prof. J.W.Lee and colleagues from BMT center of Seoul St. Mary s Hospital

33 Future goals Further training of human resources To develop laboratory To establish national HLA-registry and cord blood bank To up-grade transfusion services In order to do so we need to acquire blood irradiation and TBI equipments To develop drug support

34 Future goals To treat more patients with Auto-BMT To introduce Allo-BMT case To cover treatment cost by health insurance To broaden our international cooperation

35 Thank you for your attention