CHAPTER 1 BLOOD AND MARROW TRANSPLANTATION Editors: Dr Alan Teh Kee Hean Prof Dr Chan Lee Lee Expert Panel: Dr Alan Teh Kee Hean (co-chairperson) Prof Dr Chan Lee Lee (co-chairperson) Prof Dr Gan Gin Gin Dr Hishamshah Mohd Ibrahim Prof Dr S. Fadilah Abdul Wahid Dr Ong Tee Chuan

Table 1.1.1: Stock and Flow of Blood and Marrow Transplantation, Figure 1.1.1: Stock and Flow of Blood and Marrow Transplantation, Year New transplant patients Deaths Lost to follow- up Alive at 31 st December Year New transplant patients Deaths Lost to follow- up Alive at 31 st December ,000 Number of patients (n) Year New patientsAlive at 31st Dec

Table 1.1.2: New Transplant Rate per million population (pmp), Figure 1.1.2: New Transplant Rate per million population (pmp), Year New transplant patients New transplant rate, pmp Year New transplant patients New transplant rate, pmp New Tranplant rate pmp Year

Table 1.1.3: Distribution of Patients by Transplant Centre, Year No.% % % % % % % KLA HKLP HUKM SJMCA UMA UMP GMC LWE SJMCP HUSM APSH HA HPP Others TOTAL Year No.% % % % % % % KLA KLP UKM SJA UMA UMP GMC LWE SJP HUSM ASH HA HPP Others TOTAL

Table 1.1.3: Distribution of Patients by Transplant Centre, KLAHospital Kuala Lumpur, (Adult) KLPHospital Kuala Lumpur, Institute Paediatrics (Paed) UKMHospital Universiti Kebangsaan Malaysia SJASime Darby Medical Centre, Subang Jaya (Adult) UMAUniversity of Malaya Medical Centre (Adult) UMPUniversity of Malaya Medical Centre (Paed) GMCGleneagles Medical Centre, Penang LWELam Wah Ee Hospital, Penang SJPSime Darby Medical Centre, Subang Jaya (Paed) HUSMHospital Universiti Sains Malaysia ASHAmpang Puteri Specialist Hospital HAHospital Ampang HPPHospital Pulau Pinang Year No.% % % % % % % KLA KLP UKM SJA UMA UMP GMC LWE SJP HUSM ASH HA HPP Others TOTAL Year 2008Total No.% % KLA KLP UKM SJA UMA UMP GMC LWE SJP HUSM 6360 ASH 0020 HA HPP 2120 Others 0010 TOTAL

Figure 1.1.3: Distribution of Patients by Centre, Number of patients (n) Year GMCLWESJPHUSM ASHHAHPPOthers

Percentage of patients (%) Year MaleFemale Table 1.2.1: Distribution of Patients by Gender, Figure 1.2.1: Distribution of Patients by Gender, Year Gender No. % % % % % % % % Male Female TOTAL Year GenderNo.% % % % % % % % Male Female TOTAL Year Total GenderNo.% % % % % % % Male Female TOTAL

Table 1.2.2: Distribution of Patients by Ethnic Group, Year RaceNo.% % % % % % % % Malay Chinese Indian Bumiputra Sabah Bumiputra Sarawak Others TOTAL Year RaceNo.% % % % % % % % Malay Chinese Indian Bumiputra Sabah Bumiputra Sarawak Others TOTAL Year Total RaceNo.% % % % % % % Malay Chinese Indian Bumiputra Sabah Bumiputra Sarawak Others TOTAL

Figure 1.2.2: Distribution of Patients by Ethnic Group,

Table 1.2.3: Distribution of Patients by Age Group, Year Age groupNo.% % % % % % % % ≥ TOTAL Mean SD Median Minimum Maximum Year Age groupNo.% % % % % % % % ≥ TOTAL Mean SD Median Minimum3115 months111 month1 Max Year Total Age groupNo.% %.No.% % % % % ≥ TOTAL Mean SD Median Minimum5 months month Maximum

Figure 1.2.3: Distribution of Patients by Age Group,

Table 1.2.4: Distribution of Patients by Primary Diagnosis, Year DiagnosisNo.% % % % % % % % Acute leukaemia Chronic leukaemia Hypoplastic anaemia Erythrocytic disorders Lymphoma Solid tumors Myelodysplasia Haemoglobinopathy Multiple myeloma Others TOTAL Year DiagnosisNo.% % % % % % % % Acute leukaemia Chronic leukaemia Hypoplastic anaemia Erythrocytic disorders Lymphoma Solid tumors Myelodysplasia Haemoglobinopathy Multiple myeloma Others TOTAL Year Total DiagnosisNo.% % % % % % % Acute leukaemia Chronic leukaemia Hypoplastic anaemia Erythrocytic disorders Lymphoma Solid tumors Myelodysplasia Haemoglobinopathy Multiple myeloma Others TOTAL

Table 1.3.1: Distribution of Patients by Graft Number, Year Graft number No.% % % % % % % % TOTAL Year Graft number No.% % % % % % % % TOTAL Year Total Graft number No.% % % % % % % TOTAL Note: Missing in graft number = 71 patients (5%)

Figure 1.3.1: Distribution of Patients by Graft Number, Percentage of patients (%) Year Graft number 1Graft number 2Graft number 3

Table 1.3.2: Distribution of Patients by Transplantation Type, Year Type of transplant No.% % % % % % % % Allogeneic + Syngeneic Autologous TOTAL Year Type of transplant No.% % % % % % % % Allogeneic + Syngeneic Autologous TOTAL Year Total Type of transplant No.% % % % % % % Allogeneic + Syngeneic Autologous TOTAL

Figure 1.3.2: Distribution of Patients by Transplantation Type, Number of patients (n) Year Allogeneic+SyngeneicAutologous

Number of patients (n) KLAKLPUKMSJAUMAUMPGMCLWESJPHUSMASHHAHPPOther Centre Allogeneic+Syngeneic Autologous Table 1.3.3: Type of Transplant by Centre, Figure 1.3.3: Type of Transplant by Centre, Type of transplantAllogeneic + SyngeneicAutologousTOTAL Centre No.% % % KLA KLP UKM SJA UMA UMP GMC LWE SJP HUSM ASH HA HPP Other TOTAL

Table 1.3.4: Source of Stem Cells, Year Transplant sourceNo.% % % % % % % % Marrow PBSC / Marrow + PBSC Cord blood / Marrow + cord TOTAL Year Transplant sourceNo.% % % % % % % % Marrow PBSC / Marrow + PBSC Cord blood / Marrow + cord TOTAL Year Total Transplant sourceNo.% % % % % % % Marrow PBSC / Marrow + PBSC Cord blood / Marrow + cord TOTAL

Figure 1.3.4: Source of Stem Cells,

Table 1.3.5: Distribution of Patients by HLA Match, Year HLA MatchNo.% % % % % Identical AG AG ≥3 AG Disparate TOTAL Year HLA MatchNo.% % % % % Identical AG AG ≥3 AG Disparate TOTAL Year HLA MatchNo.% % % % % Identical AG AG ≥3 AG Disparate TOTAL Year HLA MatchNo.% % % % % Identical AG AG ≥3 AG Disparate TOTAL Year Total HLA MatchNo.% % % Identical AG AG ≥3 AG Disparate TOTAL

Table 1.3.6: Distribution of Patients by Allogeneic Donor Relationship, Year Allogeneic Donor RelationshipNo.% % % % % Sibling Unrelated  Marrow  PBSC / Marrow + PBSC  Cord blood / Marrow + cord Others TOTAL Year Allogeneic Donor RelationshipNo.% % % % % Sibling Unrelated  Marrow  PBSC / Marrow + PBSC  Cord blood / Marrow + cord Others TOTAL Year Allogeneic Donor RelationshipNo.% % % % % Sibling Unrelated  Marrow  PBSC / Marrow + PBSC  Cord blood / Marrow + cord Others TOTAL Year Allogeneic Donor RelationshipNo.% % % % % Sibling Unrelated  Marrow  PBSC / Marrow + PBSC  Cord blood / Marrow + cord Others TOTAL Year Total Allogeneic Donor RelationshipNo.% % % Sibling Unrelated  Marrow  PBSC / Marrow + PBSC  Cord blood / Marrow + cord Others TOTAL

Table 1.4.1: Distribution of Patients by Cause of Death, Year Cause of deathNo.% % % % % Sepsis GVHD Underlying disease Haemorrhage VOD Organ Failure Interstitial pneumonitis Secondary malignancy Others Unknown TOTAL Year Cause of deathNo.% % % % % Sepsis GVHD Underlying disease Haemorrhage VOD Organ Failure Interstitial pneumonitis Secondary malignancy Others Unknown TOTAL

Table 1.4.1: Distribution of Patients by Cause of Death, Year Cause of death No.% % % % % Sepsis GVHD Underlying disease Haemorrhage VOD Organ Failure Interstitial pneumonitis Secondary malignancy Others Unknown TOTAL Year Cause of death No.% % % % % Sepsis GVHD Underlying disease Haemorrhage VOD Organ Failure Interstitial pneumonitis Secondary malignancy Others Unknown TOTAL Year Total Cause of death No.% % % Sepsis GVHD Underlying disease Haemorrhage VOD Organ Failure Interstitial pneumonitis Secondary malignancy Others Unknown TOTAL

Figure 1.4.1: Patient Survival by Year of Transplant, Figure 1.4.2: Patient Survival by Gender,

Figure 1.4.3: Patient Survival by Age Group, Figure 1.4.4: Patient Survival by Type of Transplant, Cumulative survival Duration in years 0-9 years10-19 years years≥40 years

Figure 1.5.1: Disease-free Survival for Acute Myeloid Leukaemia, (Allogeneic vs. Autologous)

Figure 1.5.2: Disease-free Survival for Acute Lymphoblastic Leukaemia, (Allogeneic)

Figure 1.5.3: Disease-free Survival for Thalassaemia, (Allogeneic)

Figure 1.5.4: Disease-free Survival for Non-Hodgkin’s Lymphoma, (Allogeneic vs. Autologous)

Figure 1.5.5: Disease-free Survival for Hodgkin’s Disease, (Autologous)

Figure 1.5.6: Disease-free Survival for Chronic Myeloid Leukaemia, (Allogeneic)

Figure 1.5.7: Disease-free Survival for Aplastic Anaemia, (Allogeneic)

Figure 1.5.8: Disease-free Survival by Age Group for Acute Myeloid Leukaemia, Pediatric is defined as age  18 years and adult age >18 years.

Figure 1.5.9: Disease-free Survival by Age Group for Acute Lymphoblastic Leukaemia, Pediatric is defined as age  18 years and adult age >18 years.

Figure : Disease-free Survival by Age Group for Thalassaemia,

Figure : Disease-free Survival by Age Group for Non-Hodgkin’s Lymphoma, Pediatric is defined as age  18 years and adult age >18 years.

Figure : Disease-free Survival by Age Group for Hodgkin’s Disease, Pediatric is defined as age  18 years and adult age >18 years.

Figure : Disease-free Survival by Age Group for Chronic Myeloid Leukaemia,

Figure : Disease-free Survival by Age Group for Aplastic Anaemia, Pediatric is defined as age  18 years and adult age >18 years.