1. EXPERIENCE OF THE NBTC IN THE PREPARATION OF AHSC GRAFT IN TUNISIA PREPARED BY: NADRA GABSI LEILA BEN HAMED F. JENHANI T. BEN OTHMEN S. HMIDA E. GOUIDER M. MAAMER A. SKHIRI H. KAABI N. MOJAAT

2. Historical Overview 1958: Pr. Jean DAUSSET - discovery of the HLA system 1945: The bombings in Hiroshima and Nagasaki 1950’s Concept of "stem cell" - First clinical trials (failures) 1968: Robert A. Good -The first successful AHSCT … 1980’s: Widespread Clinical use of HSCs 1998: The first AHSCT in TUNISIA 2010 : AHSCT the only cure for many hematopoietic disorders.. 2010

3. OBJECTIVE

4. We report data of the NBTC in the preparation of the graft using manual handling over 12 years

5. MATERIALS

6. Materials February 1998 – July 2010 474 patients total. Donors: HLA-identical siblings 53% Males 47% Females Median age: 21 years (Range: 2 – 62 years)

7. DISEASES 55% 45% ACUTE LEUKEMIA APLASTIC ANEMIA MALIGNANTNON MALIGNANT (41%) (28%) (11%)(17%)

8. SOURCES OF HSCs BONE MARROW PERIPHERAL BLOOD

9. METHODS

10. Major Minor Mixed ReceiverDonor GRAFT PREPARATION ABO- incompatibility

12. Blood cell depletion (Major or mixed ABO-incompatibility) Ficoll density gradient centrifugation

13. Manual blood cell depletion (Major and mixed ABO-incompatibility) Ficoll density gradient centrifugation

14. Manual blood cell depletion (Major and mixed ABO-incompatibility) Ficoll density gradient centrifugation

16. Plasma depletion (Minor ABO-incompatibility)

17. Graft quality LamellaMalassez cell FLOW CYTOMETRY The numeration of mononuclear cells (MNC) The count of CD34+ CFU-GM (Only in the first 7 years)

18. The most crucial step Samples of high quality Sufficient number of HSCs The PREPARATION of the GRAFT SO,

19. RESULTS

20. CELLS MNC ( x 10 8 /Kg) CD34+ ( x 10 6 /Kg) MeanMedian Extreme ≥2 3.062.6 76% 3.83 3.03 0.23 – 21.83 71% 0.67 – 17

21. Correlation between MNC and CD34+ (Pearson statistical test ) P=0.000 Correlation coefficient=0.406

22. MinorCompatible Major & mixed 474 CASES TOTAL 3 groups

27. No immediate or delayed hemolysis No infectious events related to graft contamination

28. CONCLUSION

29. The manual handling of the graft slow and laborious procedure

30. conomic barriers afety of patients E S H ematological disorders

31. NCBMT Activity

32. Transition Manual handling 1998-2010 Automatic preparation

33. THANKS

34. ransfusion enter lood ational NBTCTUNISIA

35. ransfusion enter lood ational N B T C TUNISIA

36. ransfusion enter lood ational NBTCTUNISIA

37. ransfusion enter lood ational N B T C TUNISIA

38. ransfusion enter lood ational NBTCTUNISIA

39. ransfusion enter lood ational N B T C TUNISIA