Bone Marrow Transplantation in Brazil

The Bone Marrow Transplantation (BMT) has been used for the treatment of a variety of malignancies and Immunodefficiences. To date, is a well established procedure performed worldwide. The Department of Hematology of the University of São Paulo( Fundação Pró-Sangue/Hemocentro de São Paulo) is one the organizational participating in the Brazilian Bone Marrow Transplantation Program. Another institution is the Hospital Sirio Libanês in São Paulo. The Fundação Pró-Sangue (FPS) is the leading medical school in Brazil with strong orientation towards introducing new methodologies in blood-related diseases and blood transfusion. It is the largest blood bank in Brazil. In 1988, the FPS begun the BMT Program for patients with severe aplastic anemia and leukemia. Since then, more than1,000 patients received BMT from an HLA-identical sibling donor and 300 patients received an Autologous graft. The pioneering in this field was Dr. Ricardo Pasquini from Curitiba (Paraná) in 1979. In São Paulo the team was head ed by Dr. Dalton Chamone, Frederico Dulley and Celso Massumoto.

The Clinical portion of the FPS consists of the Hematology ward with 19 beds and an outpatient clinic for BMT patients. Within the hospital there are laboratories and other facilities necessary for the BMT program, such as tissue typing laboratory, laboratory for clinical chemistry, laboratory for immunology and cell culture, laboratory for clinical microbiology, blood transfusion bank, laboratory for hemostasis and Department of Pathology. Major equipment for BMT consists of Cobalt source, Blood irradiator and Cryobiology department.

Patient care activities of the FPS include treatment of all general hematologic diseases but with a strong orientation during recent years towards the intensive treatment of the hematological malignancies. Because the hospital is a major regional referral center, about 40 newly diagnosed cases of adult leukemia, 100 cases of Hodgkin and non-Hodgkin Lymphomas and 40 cases of Chronic Myeloid Leukemia begin treatment each year with intensive chemotherapy regimens.

The results of BMT in São Paulo have been outstanding and are comparable to those of other European marrow transplant centers. The BMT program was funded by a grants of Fundação Banco do Brasil Another institution is the Instituto Nacional do Câncer (InCa) in Rio de Janeiro.

Other institution is the Hospital Oswaldo Cruz with beds alocated for BMT with LAF rooms and can offer as much as 50 BMT yearly. As part of our Program is the first unrelated BM registry in Brazil (REDOME) headed by Dr. Jose Roberto Moraes.Despite the smal amount of unrelated donors it was possible to find 3 unrelated bone marrow donors for 2 patients with leukemia and one patient with Fanconi Anemia. Nowdays, the REDOME shifted to Rio de Janeiro and it has been an oustading program. Another research area is the Cryobiology department at the Centro de Criogenia Brasil headed by Sally Mizukami.

Major activities involve the marrow and peripheral blood stem cell processing. Additional responsabilities include management of marrow/blood cells with monoclonal or mafosfamide treatment. One current protocol was designed to study the efficacy of stem cell positive selection in the treatment of breast cancer. We are currently developing a cell culture technique with Interleukin-2 (IL-2) to determine the role of immunomodulation in the posttransplant setting.