Bicocca Global Health HIWA Cancer Hospital

Sualymaniah, Iraqi Kurdistan

Start-up of the first Hematopoietic Stem Cell Transplant Unit

Hiwa Cancer Hospital

In 2016, the Italian Agency for Development Cooperation (AICS) funded our project for the start-up of a HSCT center in the city of Sulaymaniyah, Iraqi Kurdistan. An Italian team of volunteers undertook the project, and the center is now autonomous and has a standard practice of autologous and allogeneic transplants. Initially, using an appropriate grid, the adequacy of the HCH was verified. A capacity-building project was then designed, aimed mainly at thalassemia major allogeneic transplantation. However, autologous and allogeneic HSCT for hematologic malignancies soon also became a priority. Our approach addressed the implementation of a sustainable HSCT program by providing experts in all the key areas of HSCT, adult and pediatric hemato-oncology, transfusion medicine, apheresis, infectious diseases, nursing, cell manipulation, molecular biology and biophysics.

We utilized a HSCT unit with six HEPA-filtered, positive pressure air sterile rooms, that was already available at HCH, but had never been used for this purpose, due to lack of expertise.

At the beginning of 2016 we launched the training program in Sulaymaniyah, running an intensive course for the local personnel, implementing the coaching method for nurses and doctors, and editing most of the HSCT protocols in line with Joint Accreditation Committee ISCT EBMT (JACIE) standards.

All the activities were planned in agreement with the HCH, with full involvement of the local personnel. The first autograft was successfully carried out in June 2016 in a man with myeloma. Afterwards, more autografts were performed in patients with lymphoma and acute leukemia. Meanwhile, the pediatricians transplanted a ß-thalassemia major child from her HLA-identical sister.

The HCH transplant team was admitted as a full member in the European Society for Blood and

Marrow Transplantation (EBMT).

Actually the Unit is completely autonomous and performed more than 300 transplants. Scientific data were published.

The professionals who carried out the project belong to the MBBM Foundation/IRCCS San Gerardo dei Tintori and are supported by the Children Global Medicine Group of the Comitato Maria Letizia Verga.

Coordinators: Andrea Biondi, Marta Canesi, Marta Verna, Maria Luisa Melzi, Valentino Conter

Essential bibliography

  • Verna M, Canesi M, Conter V, Faulkner L, Rovelli AM, Silvestri D, Majolino I, Biondi A, Nawfal Abdullah C, Faeq Mohammed V. A Hematopoietic Stem Cell Transplantation Startup in Iraqi Kurdistan: Results in Thalassemia Patients and Analysis of the Methodology. Transplant Cell Ther. 2023 May;29(5):329.e1-329.e7. doi: 10.1016/j.jtct.2023.01.018. Epub 2023 Jan 20. PMID: 36690277

  • Majolino I, Othman D, Rovelli A, et al. The Start-Up of the first Hematopoietic Stem Cell Transplantation Center in Iraqi Kurdistan: a Capacity-Building Cooperative Project by the Hiwa Cancer Hospital, Sulaymaniyah, and the Italian Agency for Development Cooperation: an Innovative Approach. Mediterr J Hematol Infect Dis. 2017 Apr 15;9(1):e2017031

  • Majolino I, Rovelli A, Vacca M, Verna M, Canesi M, Conter V, Othman D. The capacity-building approach was successful in the start-up process of the first HSCT center in Iraqi Kurdistan. Bone Marrow Transplant. 2017 Dec;52(12):1684-1685

  • Majolino I, Ipsevich F, Verna M, Rovelli A, Conter V et al. Initial Results of Peripheral-Blood Stem-Cell Mobilization, Collection, Cryopreservation, and Engraftment After Autologous Transplantation Confirm That the Capacity-Building Approach Offers Good Chances of Success in Critical Contexts: A Kurdish-Italian Cooperative Project at the Hiwa Cancer Hospital, Sulaymaniyah. J Glob Oncol. 2017 Dec 15:JGO1700101. doi: 10.1200/JGO.17.00101

  • Mohammed RN, Majolino I et al. Leukapheresis cell concentration adjustment required for a successful recovery of HSC after cryopreservation. 2020 Feb 1;92:21-25. doi: 10.1016/j.cryobiol.2019.09.011. Epub 2019 Sep 26.PMID: 31563591

  • Faulkner L, Verna M, Rovelli A, et al. Pediatric Diseases Working Party of the European Blood and Marrow Transplantation Group. Setting up and sustaining blood and marrow transplant services for children in middle-income economies: an experience-driven position paper on behalf of the EBMT PDWP. Bone Marrow Transplant. 2021 Mar;56(3):536-543

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