REVIEW Bone marrow and stem cell transplantation: Malaysian experience GG Gan 1 , A Teh 2 , LL Chan 1 , SK Cheong 3 , KM Chang 4 and HM Ibrahim 5 1 Department of Medicine, The Adult Hematology Unit, University Malaya Medical Centre, Kuala Lumpur, Malaysia; 2 Subang Jaya Medical Centre, Kuala Lumpur, Malaysia; 3 National University Hospital, Kuala Lumpur, Malaysia; 4 Hospital Ampang, Kuala Lumpur, Malaysia and 5 Institute Paediatric, Kuala Lumpur, Malaysia Malaysia conducted the first BMT in the country in 1987. Since then, there have been 1155 transplantations performed in a total of eight transplant centres. A majority of the transplantations were allogeneic, including myeloablative and nonmyeloablative. A vast majority of donors are HLA identical siblings. The mean age of transplanted patients was 26 years. The major reason for transplantation was hematological malignancies. The overall survival was 60% for allogeneic transplantation and 52% for autologous transplantation. The most common cause of death in transplanted patients was the underlying disease followed by infection-related complica- tions. Currently, the government is expanding the existing public cord blood bank as well as the local donor registry. Bone Marrow Transplantation (2008) 42, S103–S105; doi:10.1038/bmt.2008.129 Keywords: transplantation; Malaysia; autologous; allogeneic; GVHD; race The first BMT in this country was conducted on a paediatric patient in 1987 at University Malaya Medical Centre (UMMC; previously known as University Hospital) in Kuala Lumpur, Malaysia. In 1993, the first adult transplantation was performed also at the same hospital. Since then, more BMT centres in Malaysia have been set up; currently, there are totally eight such transplant centres, two of which are government owned, four are private and the remaining two are university-based. Out of the total of eight, three are currently performing paediatric transplan- tation and almost all hospitals conduct allogeneic trans- plantation. The total number of transplantations performed until 2006 was 1155, where the majority of these transplantations were allogeneic (808). Autologous SCT started in 1989, and as of the end of 2006 the total number transplanted were 347. After 1999, the number of transplantations per year has increased significantly. The annual number of trans- plantations performed ranges from 100 to 150. The calculated new transplant rate per million population in Malaysia until the end of 2005 is shown in Figure 1, which shows a spike after the year 1999 with the opening of more centres. A majority of the patients are local. There is a aslight female preponderance (48% male subjects, 52% female subjects). The largest ethnic group transplanted was the Chinese (48%) followed by the Malays (37%) and the Indians (7%). The age of transplantation ranges from 1 month to 70 years. The mean age of new transplant patients in 2005 was 26 ± 16 years. Fifty-nine per cent of the transplantations were performed in patients under the age of 19 years. Twenty-seven per cent were transplanted in those in the age group of 20–39 years and 14% in those under 60 years. Only five patients older than 60 years were trans- planted, and all are autologous SCT. The young median age reflects the paediatric bias in the registry, as transplantation in Malaysia was first started in paediatric patients. The predominant transplantation performed is sibling- related transplantation (70.7%), with the remaining auto- logous. Seventy-nine per cent of the transplant sources were from PBSCs. Cord blood transplantation was first performed at UMMC in 1997 in a paediatric patient, and an unrelated transplantation in 1997 was also performed at the same hospital. The first adult unrelated transplantation was started in 2006, and currently two centres are performing adult unrelated transplantations. Thus far, three adult unrelated transplantations have been per- formed, with one of the unrelated sources of stem cell being cord blood. An overview of types of transplant is illustrated in Figure 2. A majority of allogeneic transplantations are for malignant disorders. Most are hematological malignancies; AML being the most common disease (24%), followed by CML (11%) and ALL (11%). Other nonmalignant hematological disorders include thalassemia major (10%) and aplastic anemia (10%). However, with the availability of imatinib, CML is now no longer one of the most common diseases for transplantation. Lymphoma remains the commonest disease for autologous SCT. The major cause of death from transplantation is relapse and underlying disease. Sepsis is the second commonest cause of death. Up to the end of 2006, 41.4% patients who had undergone transplantation survived. The overall Correspondence: Dr GG Gan, Department of Medicine, The Adult Hematology Unit, University Malaya Medical Centre, Kuala Lumpur, Malaysia. E-mail: gingingan@gmail.com or gangg@ummc.edu.my Bone Marrow Transplantation (2008) 42, S103–S105 & 2008 Macmillan Publishers Limited All rights reserved 0268-3369/08 $30.00 www.nature.com/bmt