blood and marrow transplantation: jordan experienceblood and marrow transplantation: jordan...

Blood and Marrow Transplantation: Jordan Experience

The 4th WBMT Congress and Workshop – Riyadh, KSA - January 15-17, 2017

Abdelghani Tbakhi, MD, FCAP

Chairman, Department of Cell Therapy & Applied Genomics

Institution Principal Investigator- EBMT

Mahmoud Sarhan, MD

BMT Program Director

Population

Health Indicators

Socioeconomic

Indicators

Geography

Jordan

Population: 9,531,712

Presenter

Presentation Notes

Jordan is among the smaller populations in the Eastern Mediterranean region with impressive indicators related to health and a growing population that will challenge the current stable situation

Population

Health Indicators

Socioeconomic

Indicators

Geography

570 km 5 hours


Distances: 570 km north to south

Jordan

Presenter

Presentation Notes


Population

Health Indicators

Socioeconomic

Indicators

Geography

Life expectancy @ birth =74.4 Years



Jordan

Presenter

Presentation Notes


Population

Health Indicators

Socioeconomic

Indicators

Geography

Life expectancy @ birth =74.4 Years

Unemployment rate: 12.6%



Jordan

Presenter

Presentation Notes


Jordan Population

• Central Region: – Amman – Az Zarqa – Al Balqa – Madaba

• Central Region: – Amman – Az Zarqa – Al Balqa – Madaba

63%

Jordan Population

Gross Domestic Product

JOR (2015) 37.517 Billions

World Bank Data Last updated Jan 10, 2017

JOR (2015) 3976.04 US$ Per Capita

GINI index - Jordan

http://www.tradingeconomics.com/jordan/gini-index-wb-data.html, last visited January 11, 2017

GINI index in Jordan was last measured at 35.43 in 2010, according to the World Bank

Note: a Gini index of 0 represents perfect equality, while an index of 100 implies perfect inequality.

Presenter

Presentation Notes

Gini index measures the extent to which the distribution of income (or, in some cases, consumption expenditure) among individuals or households within an economy deviates from a perfectly equal distribution. A Lorenz curve plots the cumulative percentages of total income received against the cumulative number of recipients, starting with the poorest individual or household. The Gini index measures the area between the Lorenz curve and a hypothetical line of absolute equality, expressed as a percentage of the maximum area under the line. Thus a Gini index of 0 represents perfect equality, while an index of 100 implies perfect inequality. This page has the latest recorded value, an historical data chart and related indicators for GINI index in Jordan.

http://www.tradingeconomics.com/jordan/gini-index-wb-data.html

Population Pyramid , Jordan 2014

Population Pyramid of Jordan

Population Pyramid of Jordan

Population Pyramid , Jordan 2014

82%

285 45

0

550 76

9 1126

1396

33

02

3354

33

80

3362

34

12

3430

34

78

3591

36

78 41

98

4332

46

06

4798

48

49

4675

50

13

5416

250

750

1250

1750

2250

2750

3250

3750

4250

4750

5250

5750

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

No.

of C

ases

Year

Hospital-Based Population-Based

JCR

Cancer Trends in Jordan

Jordanian Department of Statistics, Jan 2016

66%

Presenter

Presentation Notes

In regard to governorates, the results showed that 4 million people, or 42 per cent of the population, live in Amman, 1.770 million in Irbid, 1.364 million in Zarqa, 549,948 in Mafraq, 491,709 in Balqa, 316,629 in Karak, 237,059 in Jerash, 189,192 in Madaba, 188,160 in Aqaba, 176,080 in Ajloun, 144,083 in Maan and 96,291 in Tafileh. Of the total non-Jordanian population, 1.265 million are Syrians, followed by Egyptians, totalling 636,270 representing 6.68 per cent of the population and Palestinians who do not have national ID numbers with 634,182 representing 6.65 per cent of the population. Iraqi nationals come next with 130,911 representing 1.3 per cent of the population, Yemenis with 31,163 representing 0.33 per cent of the population and 22,700 Libyans representing 0.24 per cent of the population. Around 197,385 people of several other nationalities also reside in Jordan, accounting for 2.07 per cent of the population. The figures showed that 49.7 per cent of the non-Jordanians residing in the Kingdom live in Amman, while 38.6 per cent of Jordanians live in the capital. On the distribution of Syrians living in Jordan, 435,578 Syrians live in Amman, 343,479 in Irbid, 207,903 in Mafraq, 175,280 in Zarqa and the rest are distributed across the country’s other governorates. Of the Palestinians who do not have national ID numbers, 308,091 live in Amman, 189,788 live in Zarqa, and 53,628 live in Jerash, while the rest live across the country’s other governorates, according to the figures. The census, which covered 1.977 million families, indicated that the largest increase in population was in 2011. Annual population growth in 2004-2015 stood at 5.3 per cent, the census showed, attributing the rise to the waves of refugees into the Kingdom. The average size of families living in Jordan dropped from 6.7 people in 1979 to 4.8 in 2015. The figures indicated that half of the country’s population is covered by health insurance. Among Jordanians, two thirds, or 66.6 per cent, have health insurance. Of Jordanians living in the capital, 50.2 per cent have health insurance, while the percentage is higher in all the other governorates. The percentage of Jordanians with health insurance in Balqa is 76 per cent, Zarqa 56 per cent, Madaba 79 per cent, Irbid 79 per cent, Mafraq 85 per cent, Jerash 88 per cent, Ajloun 95 per cent, Karak 93 per cent, Tafileh 94 per cent, Maan 88 per cent and Aqaba 77 per cent.

Annual BMT Numbers

•King Hussein Cancer Center 115-145

•Private Sector 20-30

•Royal Medical Services 20-25

•University of Jordan 5-15

KHCC / BMT per year

KHCC Stats - Demographics

Total BMT (2003-2016) 1337

Allogeneic 794 (59.4%)

Autologous 543 (40.6%)


Total BMT (2003-2016) 1337

Adults 726 (54.3%)

Pediatrics 611 (45.7%)


Total BMT (2003-2016) 1337

Males 805 (60.2%)

Females 532 (39.8%)


Total BMT (2003-2016) 1337

Jordanians 1078 (80.6%)

Non-Jordanians 259 (19.4%)

Allogeneic BMT

Donor Source Total Adults Pediatrics

Matched Sibling 638 (80.4%) 291 347 Matched Other Relative 66 (8.3%) 10 56 Mismatched Relative (one antigen mismatch) 19 (2.4%) 2 17

Haploidentical 37 (4.7%) 5 32 UCBU 31 (3.9%) 3 28 MUD 3 (0.33%) 2 1

TOTAL 794 313 (39%) 481 (61%)

KHCC Stats - Indications

Total BMT (2003-2016) 1337

Malignant 1013 (75.8%)

Non-Malignant 324 (24.2%)

BMT Indications - KHCC

Disease Number Percentage Leukemia 377 (28.2%) Lymphoma 314 (23.3%) Plasma cell Disorders 160 (12%) Solid tumors 118 (9%) MDS/MPN 44 (3%) Hemoglobinopathies 148 (11.1%) Bone Marrow Failure 118 (9%) Immunodeficiency Disorders 46 (3%) Inherited Disorders 12 (1.4%) TOTAL 1337

63.5%

BMT Indications - RMS Immunodeficiency cases (87)

Courtesy of DR. Adel Al-Wahadneh, RMS

BMT Indications - Private Total BMT ( Jan 2013- Dec 2016) = 53

Allogeneic (37, 70%) Autologous (16, 30%) Adults (14, 26%) Pediatrics (39, 74%)

Malignant (31, 58%) Non Malignant (22, 42%) Disease Category

Leukemias 13 (24.5%) Lymphomas 8 (15.1%)

Solid Tx 8 (15.1%) MDS 2 (3.8%)

Hemoglobinopathy 8 (15.1%) B.M.F 8 (15.1%)

Inherited /Autoimmun Disorders 6 (11.3%)

Average Cost for BMT (US $)

Type of Transplant Auto Allo Evaluation pre Admission 15637.13 19546.41 Transplant Admission 36734.43 45918.04 Post BMT Discharge – Day 100

19811.83 22783.61

Donor workup 4758.64 Total Average Cost

72183.39

93006.70

2Q15 3Q15 4Q15 1Q16 2Q16 3Q16BMT Unit 0.00 0.00 0.00 0.00 0.00 0.00NDNQI-Non Magnet

Hospitals Mean 1.76 1.01 1.50 1.44 2.20 7.66

-1.00

1.00

3.00

5.00

7.00

9.00

11.00

13.00

15.00

CAU

TI R

ate

Case

s per

100

0 ca

thet

er d

ays

CAUTI Rates

4Q14 1Q15 2Q15 3Q15 4Q15 1Q16 2Q16 3Q16BMT Unit 4.45 3.39 1.70 3.04 2.61 1.80 8.58 0.00NDNQI-Non Magnet

Hospitals Mean 2.58 3.23 2.64 3.03 3.37 3.03 3.53 3.02

0.00

5.00

10.00

15.00

20.00

25.00

30.00

CLAB

SI R

ate

Case

s per

100

0 ca

thet

er d

ays

CLABSI Rates

BMT in Jordan - Challenges

• Financial issues – Jordanians – Non-Jordanians – Medication prices (e.g., BEAM)

• Space and bed availability • Accommodations (patients and families)

182 Single beds (+ 172 existing => 350)(including AICU, PICU) 6 Operating Rooms 1 Emergency Room (19 beds) 1 Outpatient Building

KHCC: Future Plans

Research Interests

• Surgical complications of BMT • BMT of Myeloma and lymphomas • BMT of Thalassemia • CMV reactivation in Auto BMT • Bacterial infections • BMT Conditioning and Mobilization • Histocompatibility & Immunogenetics • Cord Blood banking • Stem cell processing

Acknowledgments KHCC Mahmoud Sarhan, MD, BMT Program Director/ BMT Consultant/ Pediatrics Rawad Rihani, MD Eman Khattab, MD Mayada Abu Shanap, MD Ayad Hussein, MD Abdul Hadi Al Zaben, MD BMT Consultant/ Adults Fawzi Abdel Rahman, Prev. BMT Program Director Husam Abu Jazar, MD Khaled Halahleh, MD Mohammed Ma’koseh, MD Omar Al Rawi, MD Nursing Department Haitham Abu Haq, BMT Unit Head Nurse Maha Yousef, BMT Program Coordinator/ Adults Fadia Al Sheab, BMT program Coordinator/ Pediatric

Department of Cell Therapy & Applied Genomics Abdelghani Tbakhi, MD, FCAP, Chairman, Shanta Sharma, PH.D., Amal Afifi, Ph.D, Wafa Elbjeirami, Ph.D Salah Albohisi, Lab Manager OSAR Nilly Hussein, BMT Program Data Manager Pharmacy Rula Najjar, BMT Pharm. D Royal Medical Services Adel Wahadneh, MD Nazmi Kamal, MD University of Jordan Abdulla Al-Abbadi Private Sector Mohammad Salameh Maisara Alqam

blood and marrow transplantation: jordan experienceblood and marrow transplantation: jordan...

Documents