Shining a Spotlight on International Hematology Research and Initiatives

The 2017 ASH Annual Meeting marked the debut of the “Global Capacity-Building Showcase,” a new poster category for research and capacity-building initiatives in low- and middle-income countries. Nearly 30 projects ran the gamut from recruiting and training a hematology workforce to establishing new clinics and improving access to treatments that are widely available in developed countries.

Twelve posters were featured during the Global Capacity-Building Showcase and were published in a special annual meeting print edition of Blood Advances. Below is a selection of the projects presented.

Preventing Stroke in Children With Sickle Cell Anemia in Nigeria

Stroke is a devastating, preventable complication of sickle cell anemia (SCA), but primary stroke-prevention teams for children with SCA in Africa are lacking. To help mitigate this risk – while working within resource constraints – Najibah A. Galadanci, MD, from the Departments of Hematology and Blood Transfusion at the Bayero University/Aminu Kano Teaching Hospital in Kano, Nigeria, and colleagues established small, three-member stroke-prevention teams at tertiary-care hospitals in the area.

Each stroke-prevention team consisted of a pediatrician, nurse, and radiologist. Team members were trained in National Heart, Lung, and Blood Institute sickle cell disease (SCD) management guidelines – adapted for medical care in low-resource settings – and a pediatric neurologist provided instructions on how to detect a stroke and stroke-related comorbidities. Each clinic was also staffed with a trained multidisciplinary team and a certified radiologist to conduct transcranial doppler ultrasound (TCD) screening.

With support from international partners in the United Kingdom and the United States, the teams were trained and installed at four tertiary-care hospitals in Nigeria in January 2017. Since then, 1,249 children with SCA have been screened using TCD. Most were referred to a clinical trial, and of the 7 percent who were not, many have started on routine care with daily hydroxyurea 20 mg/kg.

Based on the initial success, “we fully anticipate that the primary stroke prevention teams will continue screening and identifying children with SCD in four major hospitals in Kano, Nigeria,” the authors concluded.

Galadanci NA, Abdullahi SU, Suwaid S, et al. Implementing standard of care clinic for stroke prevention in children with sickle cell disease in Nigeria: a feasible strategy outside a clinical trial setting. G-8.

Treating Chronic Myeloid Leukemia for the First Time in Cambodia

Given the mortality and morbidity from infectious diseases and perinatal complications in Cambodia, few resources are expended on pediatric cancer programs. Prom Vireak, MD, from Angkor Hospital for Children (AHC) in Siem Reap, Cambodia, and colleagues reported the first case of chronic myeloid leukemia (CML) treated at their center – an achievement made possible through several international collaborations, the researchers noted.

The first-of-its-kind oncology program was established in 2013 with support from the American Society of Hematology and Health Volunteers Overseas (ASH-HVO) program.

The patient, a 12-year-old girl, presented at the AHC’s pediatric oncology program with headache, bone pain, and abdominal pain for one month. Peripheral blood and bone marrow samples were collected, then sent for diagnostic testing at U.S. sites. Results from this analysis confirmed a diagnosis of chronic-phase CML.

Imatinib – a tyrosine kinase inhibitor (TKI) – is not available at AHC, so the patient was treated at a hospital in Phnom Penh. After three months of treatment, her disease saw substantial clinical improvement, with meaningful reductions in spleen volume, Dr. Vireak and colleagues reported. “Through the global collaborative efforts led by AHC and ASH-HVO, CML is the first type of leukemia to be treated at AHC, and this has helped improve oncology care for children in Cambodia,” they wrote. “AHC now provides care and close monitoring to four patients with CML.”

Still, TKI therapy for CML is prohibitively expensive and not available in Cambodia, the authors noted, highlighting the value of international collaborations between low-resource settings and developed countries where these treatments are a routine part of clinical practice.

Vireak P, Heng S, Kea S, et al. Successful treatment of pediatric CML in Cambodia– an international collaboration. G-20.

Improving Diagnosis and Care of Children With Blood Diseases in the Caribbean

Michelle Reece-Mills, MD, from the University Hospital of the West Indies in Kingston, Jamaica, highlighted the work of the SickKids-Caribbean Initiative (SCI) – a collaboration between The Hospital for Sick Children in Toronto (also known as SickKids) and seven Caribbean institutions that launched in 2013. SCI focuses on building sustainable, local capacity to diagnose, treat, and manage blood diseases in children living in six Caribbean countries: the Bahamas, Barbados, Jamaica, Saint Lucia, Saint Vincent and the Grenadines, and Trinidad and Tobago.

After surveying the needs of SCI partners throughout the region, the program identified several objectives to improve – and sustain – in patient care:

  • provide training and education in the areas of hematology/oncology, nursing, and laboratory services
  • establish best practices and improve health outcomes through the development and maintenance of local hospital-based pediatric oncology databases and treatment protocols adapted for local use
  • establish an integrated and sustainable communication structure for bidirectional education among local partners

Together, these goals would help create “a regional community of practice,” the researchers noted. At the annual meeting, Dr. Reece-Mills shared several SCI success stories since the program’s launch, including:

  • conducting 37,578 newborn SCD screening tests for children in Jamaica and St. Lucia at the Caribbean Institute for Health Research
  • expanding the workforce to include 26 nurses from SCI partner countries who completed the pediatric hematology/oncology nursing diploma program at the University of the West Indies School of Nursing in Trinidad
  • registering 457 patients in local, custom-built oncology databases established in SCI partner hospitals
  • establishing 7 telemedicine facilities throughout partner countries
  • publishing 9 locally adapted supportive care and clinical care guidance documents

Reece-Mills M, Alexis S, Allen U, et al. SickKids-Caribbean Initiative: Collaborating to improve the diagnosis and care of children with cancer and serious blood disorders in the Caribbean. G-27.