How does transplantation work in centers where transplants are not performed?

Abstract

Hematological malignancies are frequently severe and aggressive diseases that require an intensive strategy for their management. Bone marrow transplantation (BMT) is in many cases the only way to achieve cure or prolonged survival. In the present time, there is not a formal program for BMT for people with hematologic diseases in public health services. To achieve a transplant for a patient requires a complex administrative process to get a subsidy from the State, making access not equal for every patient. The aim of this analysis is to describe the clinical and socioeconomic characteristics, the time to transplant, sources of financial support and explore its possible association with survival in a cohort of unselected patients from a Public Hospital in Buenos Aires City (CABA) that underwent a BMT from 2000 to 2017. We also analyze data from a briefly time registry, evaluating those BMT performed / not performed and their possible causes.
During this period 88 patients underwent BMT, 50 autologous and 38 allogeneic (8 where unrelated and 6 haploidentical). Financing was supported by State (CABA) in 40.9%. Time to transplantation was larger in patients without any other insurance than Public Hospital (8,37 vs. 3,8 month for those who did have insurance), and more patients in this group tend to fail achieving BMT than those with another kind of funding than the State.
Access of all kinds of patients is improving on last years as number of BMT done in our patients is increasing. 
Given the small number of patients and the heterogeneity of each group in terms of diagnoses and type of BMT, no other statistical significant analysis could be made. Efforts are being made to change the complex administrative procedures to achieve BMT for those patients who are completely dependent on the public health system of the city government of Buenos Aires, and also to register the real needs of transplants of our population. Probably these changes will improve the unequal access to best therapeutics tools of all patients.