Treatment of oncohematological diseases is a complex and expensive matter. A radical method of treatment is bone marrow transplantation (BMT). This method is used to treat the most aggressive forms of tumor diseases of the blood system.
The number of transfers is growing
About 100,000 transplants are performed in the world per year, and more than a third of them (about 32,000) are allogeneic (that is, cells are taken from a donor). In 2021, 1800–1900 were heldin world, for comparison, in 2015 there were 1651 of them.
As the number of patients increases and the number of transplants increases throughout the country, the number of complications after operations also increases. This includes an increase in the number of graft-versus-host reactions. This complication is immunologically mediated organ damage, in which donor immune cells recognize recipient (“host”) organs and tissues as “foreign” and begin to fight them. As a result, an immune reaction is triggered, leading to damage to one’s own tissues, which negatively affects the results of the transplant itself.
GVHD affects 30% to 40% of patients. Among all dead patients who underwent cell transplantation from related donors, 21-31% die precisely because of this complication, and if the donors of transplanted cells were not relatives, then the percentage of deaths is even higher (31-40% of all cases).
“GVHD manifests as skin rashes, gastrointestinal disturbances, liver damage, and other addiction symptoms. The acute form occurs approximately 25-30 days after transplantation, the chronic form appears most often after 100 days, ”says Mikhail Drokov, Head of the Sector for Scientific Research on Chemotherapy for Hemoblastoses, Hematopoietic Depressions and Bone Marrow Transplantation, National Medical Research Center for Hematology. – And if doctors can recognize the acute form in time, then everything is much more complicated with the chronic one. After all, its symptoms occur, as a rule, when the patient is already discharged from the hospital. And this entails the need for the active participation of local doctors in the fate of these patients.”
In the area of special attention
Although BMT is paid for by the state, it has not yet included funding for the treatment of late complications. The order of medical care that regulates the procedure does not include issues related to the important post-transplant period for the patient. The situation is especially difficult in the regions. “Due to the lack of a clear system for routing patients after BMT, many of them do not have access to the necessary life-saving therapy. Today, it is necessary to achieve uniformity of medical care after BMT, despite the complexity of clinical practice, to build the stages of monitoring the condition of patients and provide them with the necessary drug therapy. All these are urgent needs to reduce mortality rates as a result of GVHD, ”says General Director of LLC “National Institute of Medical Law” Yulia Pavlova.
Drug provision of patients with GVHD is possible through existing programs, in particular, the program “14 high-cost nosologies” (14 VZN). “The program makes it possible to provide patients with drugs after organ and tissue transplantation. But the list of such drugs in the program is limited, and includes only basic drugs for immunosuppressive therapy (suppressing immunity to prevent the rejection of donor cells), and does not cover glucocorticosteroids, as well as targeted therapy prescribed for non-responsive to traditional therapy. The provision of these drugs should be carried out at the expense of the budgets of the constituent entities , but in fact we see that some patients are forced to buy them themselves or seek help from our Leukemia Foundation or other charitable organizations, ”said Yulia Sinitsyna, Program Director of the Leukemia Foundation Charitable Foundation.