The Lagos University Teaching Hospital (LUTH), in partnership with the Sickle Cell Foundation Nigeria (SCFN), has kicked off a bone marrow transplant programme, introducing a life-saving sickle cell cure into Nigeria’s public health system.
According to Mayo Clinic, a bone marrow transplant infuses healthy blood-forming stem cells into the body to replace bone marrow that is not producing enough healthy blood cells.
The procedure, also known as blood stem cell transplants, saves about 8,000 lives of people suffering blood cancers yearly, from young children to old adults.
According to the National Institutes of Health, Nigeria has the largest population of persons afflicted by sickle cell disease globally, with over 4.3 million (2 percent) of its population affected.
LUTH has worked for several years to establish the programme in line with international standards, making it accessible to Nigerians.
The programme covers newborn screening, penicillin prophylaxis, and Transcranial Doppler screening in children to identify those at risk of stroke, chronic blood transfusion therapy and hydroxyurea therapy.
This combination is targeted at improving the proportion of children surviving into adulthood.
Bone marrow transplant using a donor marrow from a family member is an established cure for sickle cell disease, first used more than 30 years ago.
The procedure is associated with known complications such as infection and graft-versus-host disease (when donor cells can attack the patient), infertility, and even death.
However, it has been much improved over the last 20 years to ensure good outcomes and limit complications. Bone marrow transplant is now an approved therapy for children and adults with severe sickle cell disease.
It requires a multidisciplinary team approach and involves treatment and close follow-up for approximately 12 months.
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The complexity and costs have severely limited those who can obtain this treatment, and most have sought this treatment outside Nigeria, causing severe hardship for patients and families, only to come home with no local expertise for follow-up.
In preparation for a locally adapted and cost-effective bone marrow transplant programme in Nigeria, a post-transplant clinic was initially established in 2019, a first in sub-Saharan Africa, to provide post-transplant care to patients who had travelled to other countries for bone marrow or stem cell transplants, thereby developing clinical expertise in post-transplant care.
The programme also established a Stem Cell Processing Laboratory, the first in West Africa.
The LUTH/SCFN bone marrow transplant programme consists of a high-level multidisciplinary team that includes paediatric and adult haematologists, including Seye Akinsete, team lead and Ugonna Fakile, Olufunto Kalejaiye, Yusuf Adelabu, and professor Edamisan Temiye, the Programme manager, blood transfusion and stem cell processing lab support, professor Titi Adeyemo and Ann Ogbenna. It also consists of bone marrow-transplant nurses, dieticians, social workers, pharmacists, psychiatrists, anaesthesiologists, KidsOR (theatre) nurses and other ancillary personnel.
The programme is guided by the scientific expertise and leadership of Professor Adetola Kassim of Vanderbilt University Medical Center, who joined the program in 2018.
To further strengthen their expertise in the program, Prof Josu de la Fuente from the Imperial College London Healthcare NHS Trust UK joined the team in 2022 as a resource person and assisted with the paediatric aspects of the programme.
Transplant Nursing has been supported by the Worldwide Network for Blood and Marrow Transplantation (WBMT), which offers in-person and virtual training at periodic intervals.
The role of Sickle Cell Foundation Nigeria (SCFN) in this Public Private Partnership has been invaluable – providing administrative and project management oversight under the leadership of the CEO, Annette Akinsete and the invaluable support of Olu Akinyanju, Founder of SCFN.
The first set of patients are currently undergoing bone marrow transplants at Lagos University Teaching Hospital and were admitted in the last week of August 2024.
They received a treatment regimen of exchange blood transfusions, chemotherapy and anti-infective prophylaxis to prepare them for the infusion of bone marrow stem cells that were harvested from family donors, processed and given this week (17th and 19th September 2024).
Both patients are currently undergoing immediate post-transplant care within the transplant unit at Lagos University Teaching Hospital.
