cord blood banking in brazil hospital israelita albert ... › media2008 › pdf ›...
TRANSCRIPT
-
CORD BLOOD BANKING IN BRAZIL
HOSPITAL ISRAELITA ALBERT EINSTEIN’S
EXPERIENCE
JOSÉ MAURO KUTNER, MDMEDICAL DIRECTOR – BLOOD BANK
CORD BLOOD BANKING IN BRAZIL
HOSPITAL ISRAELITA ALBERT EINSTEIN’S
EXPERIENCE
JOSÉ MAURO KUTNER, MDMEDICAL DIRECTOR – BLOOD BANK
-
Brazil - South AmericaBrazil - South America
*
*SÃO PAULO
BARCELONA
-
Brazil - South AmericaBrazil - South America
Population 2008 193 millions2005 1,6%2007 US$ 1.3 trillions
GDP Growth 2007GDP per capita 2007 US$ 9,700Expenses with Health 2007 US$ 25.0 billions
Brazil
Population GrowthGDP – Gross Domestic Product
160% (over 2002)
-
Brazil - South AmericaBrazil - South America
Population 2008 193 millions2005 1,6%2007 US$ 1.3 trillions
GDP Growth 2007GDP per capita 2007 US$ 9,700Expenses with Health 2007 US$ 25.0 billions
Brazil
Population GrowthGDP – Gross Domestic Product
160% (over 2002)
9th economy in the world
-
Brazilian PopulationBrazilian Population
DEMOGRAPHIC INDICATORS 2007
• Birth Rate 20.4 / 1,000
• Child Mortality Rate (/1,000) 25 / 1,000
• Life Expectancy Men 67.9 years
Women 75.5 years
-
Life Expectancy in BrazilLife Expectancy in Brazil
68,9
63,166
606264666870
1980 1990 2000
• 2003: 6,5 millions > 60 years old
• 2025: 25 millions > 60 years old
-
SÃO PAULO, BRAZILSÃO PAULO, BRAZIL
SÃO PAULO , BRAZIL
* largest city in Brazil
* 11 million inhabitants (18 millions in Great SP)
* southeast region
* strong economy = industries, services
-
HOSPITAL ISRAELITA ALBERT EINSTEIN
HOSPITAL ISRAELITA ALBERT EINSTEIN
-
HOSPITAL ISRAELITA ALBERT EINSTEIN
HOSPITAL ISRAELITA ALBERT EINSTEIN
Characteristics
* General Hospital (Jewish Community)* Non-profit institution, private institution* Foundation 1970* 334th largest company in the country
(sales) *
* 2007 sales = US$ 400 millions
* Revista Exame 01/08/2008
-
HOSPITAL ISRAELITA ALBERT EINSTEIN
HOSPITAL ISRAELITA ALBERT EINSTEIN
* Beds = 460 (2008) 700 (2010)* Surgeries/year = 26,000 * Deliveries/year = 3,100* Liver Transplantations / year = 115* Total Transplantations / year = 210* Employees = 6,700
-
HOSPITAL ISRAELITA ALBERT EINSTEIN
HOSPITAL ISRAELITA ALBERT EINSTEIN
-
HOSPITAL ISRAELITA ALBERT EINSTEIN
HOSPITAL ISRAELITA ALBERT EINSTEIN
-
HOSPITAL ISRAELITA ALBERT EINSTEIN
HOSPITAL ISRAELITA ALBERT EINSTEIN
-
HOSPITAL ISRAELITA ALBERT EINSTEIN
HOSPITAL ISRAELITA ALBERT EINSTEIN
-
HOSPITAL ISRAELITA ALBERT EINSTEIN
HOSPITAL ISRAELITA ALBERT EINSTEIN
BLOOD BANK (Hemotherapy Department)
* collects all the Hospital´s needs* pheresis program (donations and therapeutics)* perioperative salvage* stem cell program* cord blood program (public)* performs all tx dx testing (incl. NAT – HIV/HCV)* immunohematology lab (incl. molecular biology)* cryopreservation lab (BM/PBSC/CB)
-
HOSPITAL ISRAELITA ALBERT EINSTEIN
HOSPITAL ISRAELITA ALBERT EINSTEIN
BLOOD BANK (Hemotherapy Department)
* 90 employees* 12,000 whole blood collections / year* 1,200 platelet pheresis / year* 950 cord blood donations / year
-
HOSPITAL ISRAELITA ALBERT EINSTEIN
HOSPITAL ISRAELITA ALBERT EINSTEIN
BLOOD BANK (Hemotherapy Department)
• ISO 9000 certified since 1997;• AABB accredited since 1998
(scope includes donor center / transfusion services / hematopoietic progenitor cells / cord blood) ;
• AABB Imunohematology Reference Lab accredited since 2008
• US Joint Commission accredited since 2000• working for FACT accreditation
AABB = former American Association of Blood Bankspresently Advancing Transfusion and Cellular Therapies Worldwide
-
CORD BLOOD BANKING
* HOSPITAL ISRAELITA ALBERT EINSTEIN
* BRAZIL
-
CORD BLOOD BANKING ATHOSPITAL ALBERT EINSTEIN CORD BLOOD BANKING AT
HOSPITAL ALBERT EINSTEIN
• 2001 – 2004
PRIVATE CORD BLOOD BANKING
• 2004 – PRESENT
PUBLIC CORD BLOOD BANKING
-
CORD BLOOD BANKING ATHOSPITAL ALBERT EINSTEIN CORD BLOOD BANKING AT
HOSPITAL ALBERT EINSTEIN • 2001 – 2004
PRIVATE CORD BLOOD BANKING
WHY PRIVATE BANKING?
- UNAVAILABILITY OF FUNDING FOR PUBLIC BANK
- STRONG DEMAND FROM HOSPITAL´S PATIENTS (PRIVATE)
- AT THAT TIME, UNAVAILABILITY OF OTHER PRIVATE BANKS
- AVAILABILITY OF THE METHODOLOGY AT HOSPITAL ALBERT EINSTEIN
-
CORD BLOOD BANKING ATHOSPITAL ALBERT EINSTEIN CORD BLOOD BANKING AT
HOSPITAL ALBERT EINSTEIN • 2001 – 2004
PRIVATE CORD BLOOD BANKING
- APPROXIMATELY 1050 PRIVATE UNITS FROZEN
- PROGRAM CLOSED ON SEPTEMBER 2004:
* NO CLEAR BENEFITS PROVEN FOR PATIENTS
* AVAILABILITY OF OTHER PRIVATE BANKS
* GOAL TO DEVELOP A PUBLIC BANK
* PUBLIC BANK WOULD HAVE STRONGER BENEFIT FOR THE POPULATION
-
CORD BLOOD BANKING ATHOSPITAL ALBERT EINSTEIN CORD BLOOD BANKING AT
HOSPITAL ALBERT EINSTEIN • 2004 - PRESENT
PUBLIC CORD BLOOD BANKING
- HOSPITAL´S OWN FUNDING- APPROXIMATELY US$ 20 MILLIONS- COLLECT , PROCESS , FREEZE 12,000 UNITS- 3 CENTERS FUNDED BY HIAE:
* HOSPITAL ALBERT EINSTEIN , SÃO PAULO (PRIVATE)* CAMPINAS BLOOD CENTER , CAMPINAS (PUBLIC)* RIBEIRÃO PRETO BLOOD CENTER , RIBEIRÃO PRETO (PUBLIC)
-
CORD BLOOD BANKING ATHOSPITAL ALBERT EINSTEIN CORD BLOOD BANKING AT
HOSPITAL ALBERT EINSTEIN • 2004 - PRESENT
PUBLIC CORD BLOOD BANKING
- 3 CENTERS FUNDED BY HIAE:
HOSPITAL ALBERT EINSTEIN , SÃO PAULO
OPERATING SINCE OCTOBER / 2004
CAMPINAS BLOOD CENTER , CAMPINAS
OPERATING SINCE JULY / 2007
RIBEIRÃO PRETO BLOOD CENTER , RIBEIRÃO PRETO
OPERATING SINCE AUGUST / 2008
-
CORD BLOOD BANKING ATHOSPITAL ALBERT EINSTEIN CORD BLOOD BANKING AT
HOSPITAL ALBERT EINSTEIN • 2004 - PRESENT
PUBLIC CORD BLOOD BANKING
- ALL CENTERS WITH BIOARCHIVES (3)
- PROGESA (MAK-SYSTEM´S SOFTWARE) UNDER IMPLEMENTATION
- RE-EQUIPMENT OF HIAE´S HLA LABORATORY – LUMINEX
- SEPACS system
-
CORD BLOOD BANKING ATHOSPITAL ALBERT EINSTEIN CORD BLOOD BANKING AT
HOSPITAL ALBERT EINSTEIN • 2004 - PRESENT
PUBLIC CORD BLOOD BANKING
OCTOBER / 2004 – NOVEMBER / 2008:
4,154 CORD BLOOD UNITS COLLECTED
3,052 CORD BLOOD UNITS FROZEN
1,461 UNITS AVAILABLE FOR USE (HLA + TX DX TESTING)
-
CORD BLOOD BANKING ATHOSPITAL ALBERT EINSTEIN CORD BLOOD BANKING AT
HOSPITAL ALBERT EINSTEIN
38
237
83
940 989 952
806
104
0
200
400
600
800
1000
1200
à partir deout/2004
2005 2006 2007 jan-nov / 2008
CB Units - Hosp. Campo Limpo since oct/06
CB Units - Hosp. Isr. Albert Einstein since oct/04
38
237
83
940 989 952
806
104
0
200
400
600
800
1000
1200
à partir deout/2004
2005 2006 2007 jan-nov / 2008
CB Units - Hosp. Campo Limpo since oct/06
CB Units - Hosp. Isr. Albert Einstein since oct/04
-
CORD BLOOD BANKING ATHOSPITAL ALBERT EINSTEIN CORD BLOOD BANKING AT
HOSPITAL ALBERT EINSTEIN
42
290
220
200
400
600
800
1000
1200
2007 2008
CB Units Campinas Blood Center CB Units Ribeirão Preto Blood Center
42
290
220
200
400
600
800
1000
1200
2007 2008
CB Units Campinas Blood Center CB Units Ribeirão Preto Blood Center
-
CORD BLOOD BANKING ATHOSPITAL ALBERT EINSTEIN CORD BLOOD BANKING AT
HOSPITAL ALBERT EINSTEIN
3,052 CORD BLOOD UNITS FROZEN
1,461 AVAILABLE FOR USE (HLA/TX DX TESTING)
MAIN LIMITATION FOR AVAILABILITY :
QUARANTINE PERIOD (2nd SET OF TX DX TESTING ) > 2 MONTHS AFTERDONATION
-
CORD BLOOD BANKING ATHOSPITAL ALBERT EINSTEIN CORD BLOOD BANKING AT
HOSPITAL ALBERT EINSTEIN
CORD BLOOD UNITS SENT FOR TRANSPLANTATIONBY HIAE
46 UNITS
35 ENGRAFTED2 DIED BEFORE BMT9 WAITING FOR REPORTS
-
CORD BLOOD BANKING ATHOSPITAL ALBERT EINSTEIN CORD BLOOD BANKING AT
HOSPITAL ALBERT EINSTEIN
-
Bone Marrow Transplantationin Brazil
Bone Marrow Transplantationin Brazil
BONE MARROW TRANSPLANTATION AT HOSPITAL ALBERT EINSTEIN
• PROGRAM STARTED 1987
• TRANSPLANTS PERFORMED = 573
431 AUTOLOGOUS
ALLOGENEIC 99BM/PBSC
43 ALLOGENEIC CORD BLOOD ( 7 DOUBLE CB)
-
Bone Marrow Transplantation
Cord Blood Banking
In Brazil
Bone Marrow Transplantation
Cord Blood Banking
In Brazil
-
Bone Marrow Transplantation in BrazilBrazilian Law on BMT / CBBanking
Bone Marrow Transplantation in BrazilBrazilian Law on BMT / CBBanking
• Law RDC 153 June 2004
- rules hemotherapy, incl. human blood / marrow / cord blood
- all technical aspects of the procedures
- donation must be sigilous (recipient can’t know the donor)
- non-paid donation
- donor must sign informed consent
- donor > 18 y.o. < 36 y.o.
- gestational age > 35 weeks
- fetus > 2 kg
- no infection / malformation / congenital abnormalities /known hereditary diseases /
-
Bone Marrow Transplantation in BrazilBrazilian Law on BMT / CBBanking
Bone Marrow Transplantation in BrazilBrazilian Law on BMT / CBBanking
• Law RDC 153 June 2004 (cont’d)
- mother must be submitted to Tx Disease Testing
- Tx Dx Testing :
same as for Whole Blood =
- HIV- HCV- HBV- Chagas- Syphilis- Hemoglobin Electrophoresis
+ CMV IgM / Toxoplasmosis IgM / Bacterial Culture
- test for Phenylcetonuria + Hypothyroidism + Sickle Cell Disease
-
Bone Marrow Transplantation in BrazilBrazilian Law on BMT / CBBanking
Bone Marrow Transplantation in BrazilBrazilian Law on BMT / CBBanking
• Law RDC 153 June 2004 (cont’d)
- Tx Disease Testing at donation AND > 2 months after birth
- child must be submitted to medical examination > 2 months after birth
- nucleated cells > 5 x 108 OR volume > 70 mL
- also rules autologous and directed collections
• Every use of CB must go through the Government , even if from abroad(Nat’l Cancer Institute – Rio de Janeiro)
• Governm’t rules export / import of CB
-
Bone Marrow Transplantationin Brazil
Bone Marrow Transplantationin Brazil
• BMT / patients
– Present needs for BMT (estimate) 5100 / year
– Patients with a related donor 1785 / year
– Patients without a related donor 3315 / year
– BMT 1500 / year
– Patients without an available source of HPC ~ 1700 a 2000/year
• BMT / patients
– Present needs for BMT (estimate) 5100 / year
– Patients with a related donor 1785 / year
– Patients without a related donor 3315 / year
– BMT 1500 / year
– Patients without an available source of HPC ~ 1700 a 2000/year
Dr. L.F.Bouzas - 2007
-
Bone Marrow Transplantationin Brazil
Bone Marrow Transplantationin Brazil
55 Centers for BMT
MEDICAL CENTERS FOR BMT IN BRAZIL
15 non related
Dr. L.F.Bouzas
-
0100.000200.000300.000400.000500.000600.000700.000800.000900.000
1.000.000
até2000
2001 2002 2003 2004 2005 2006 2007 2008
940,000 DONORS REGISTERED
R E D O M E - DONORS REGISTERED UNTIL DEC / 2008OBS. 2007 DATA JAN-MAY ONLY
Dr. L.F.Bouzas
Bone Marrow Transplantationin Brazil
Bone Marrow Transplantationin Brazil
OESP – 30 dez 08 and
-
Cord Blood Transplantationin Brazil
Cord Blood Transplantationin Brazil
RENACORD
Hosp. Albert Einstein
São Paulo
Blood CtrCampinas
(8 more planned)
INCARio de Janeiro
Blood CtrCampinas
Campinas
Blood CtrRib.Preto
Ribeirão Preto
REDOME Brazilian National Marrow Registry
Transplant Center Transplant Center
Dr. L.F.Bouzas
-
Cord Blood Collection CentersCord Blood Collection Centers
* **
*
Rio de Janeiro
São Paulo
Ribeirão Preto
Campinas
** *
***
* 8 more planned
-
Cord Blood Collection CentersCord Blood Collection Centers
* **
*
Rio de Janeiro
São Paulo
Ribeirão Preto
Campinas
** *
***
* 8 more planned Rio Grande do Sul
Santa Catarina
Paraná
Minas Gerais
Brasília
Pernambuco
Maranhão
Pará
-
PROJETO REDOME
Dr. José Roberto Moraes
-
Brazilian Ethnic DiversityBrazilian Ethnic Diversity
* **
**
* **
**SOUTH- Europeans :
portuguesegermansitaliansoriental Europe
SOUTHEAST- Europeans :
portuguesegermansitaliansspanishjapanese
NORTHEAST- Europeans
portuguese- Africans
NORTH- Indians- Africans- Europeans
Source: Wikipedia, 2009
-
Brazilian Ethnic DiversityBrazilian Ethnic Diversity
* **
**
* **
**SOUTH- Europeans :
portuguesegermansitaliansoriental Europe
SOUTHEAST- Europeans :
portuguesegermansitaliansspanishjapanese
NORTHEAST- Europeans
portuguese- Africans
NORTH- Indians- Africans- Europeans
Ethnic Groups:- white 49 %- mulato 43 %- black 7 %- indians 0.3 %- yellow 0.5 %
Source: Wikipedia, 2009
-
Cord Blood Transplantationin Brazil
Cord Blood Transplantationin Brazil
GOALS :
• REACH 60,000 UNITS WITHIN THE SYSTEM (12 CENTERS);
• INTEGRATION WITH INTERNATIONAL REGISTRIES
Dr. L.F.Bouzas
Source: HEMO em revista #6-2008 p.45
-
Cord Blood Transplantationin Brazil
Cord Blood Transplantationin Brazil
PUBLIC CORD BLOOD BANKING
PRESENT INVENTORY WITHIN 4 INSTITUTIONS OPERATING:
8,868 CORD BLOOD UNITS COLLECTED
6,079 CORD BLOOD UNITS FROZEN
2,529 UNITS AVAILABLE FOR USE (HLA + TX DX TESTING)
-
Cord Blood Transplantationin Brazil
Cord Blood Transplantationin Brazil
UNTIL JUNE / 2008 :
- 56 BMT PERFORMED WITH CORD BLOOD UNITS ORIGINATED FROM BRASILCORD (incl. Hosp.Alb.Einstein’s)
- 182 BMT PERFORMED WITH CBU ORIGINATED ABROAD
Source: HEMO em revista #6-2008 p.45
-
Neutrophils and Platelets EngraftmentNeutrophils and Platelets EngraftmentDr. L.F.Bouzas
Cord Blood Transplantationin Brazil
Cord Blood Transplantationin Brazil
-
Cord Blood Transplantationin Brazil
Cord Blood Transplantationin Brazil
OVERALL SURVIVALwith CB Tx
Dr. L.F.Bouzas
-
Cord Blood Transplantationin Brazil
Cord Blood Transplantationin Brazil
Overall Survival withNon Related
Hematopoietic Stem Cells (2007)BM vs PBSC vs CB
( 287 Tx)
Overall Survival withNon Related
Hematopoietic Stem Cells (2007)BM vs PBSC vs CB
( 287 Tx)
N Median OS 95% CI
BM 142 5.36 3.42 to 7.30
PB 31 3.23 1.08 to 5.38
CB 114 4.90 2.44 to 7.35
p = 0.27
Dr. L.F.Bouzas
-
CB Collection TeamHospital Albert Einstein
Hematopoietic Progenitor Cells TeamHospital Albert Einstein
- Dr. Luiz Fernando Bouzas – National Cancer Institute, Rio de Janeiro
- Hospital Israelita Albert Einstein's BMT/ Hemotherapy Teams/ Dra Andreza Ribeiro
-
GRACIAS / GRÀCIES [email protected]