REVIEW Hematopoietic stem cell transplantation in Oman D Dennison, S Al Kindi, A Pathare, S Daar, N Nusrat, J Ur Rehman, F Zia, H Khan, M Irfan Khan, A Alghazaly, S Al Zadjali, M Tauro, AT Al Lawatia and SS Ganguly Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman Hematopoietic SCT (HSCT) is an integral part of the management of patients with hematologic disorders. The Sultanate of Oman, with a population of 2.3 million, has an HSCT program based in the Sultan Qaboos University (SQU) hospital. Initiated in 1995, this two-bed unit continues to be the only program in the country. Between June 1995 and August 2006, a total of 128 patients underwent HSCT in this center, averaging about 10–12 transplants per year. The median age of these patients was 11 years (2 months to 45 years). Hematologic malig- nancies (49%) and inherited disorders (42%) constituted the major transplant indications, whereas BM failure accounted for the remaining. The majority of transplants carried out so far have been HLA-matched sibling-donor allogeneic HSCTs. Among the inherited disorders, homo- zygous beta-thalassemia and primary immunodeficiency are important transplant indications in this center. The approximate cost of an uncomplicated transplant in this center is US$50 000. The success of this program has now led to the initiation of a new and larger HSCT complex to provide the opportunity for more patients to benefit from this treatment modality within the country. Bone Marrow Transplantation (2008) 42, S109–S113; doi:10.1038/bmt.2008.131 Keywords: Oman; transplant; allogeneic; inherited; thalassemia; immunodeficiency Introduction Over the past three decades, hematopoietic SCT (HSCT) has become a vital therapeutic modality in the management of a variety of hematologic malignancies and inherited disorders. 1,2 Once confined mainly to highly advanced centers in the United States and Europe, HSCT is now available in many centers worldwide. The Sultanate of Oman, with a population of 2.3 million (Omani 1.78 million, expatriate 0.56 million), 3 started its program in 1995 as an initiative of the hematology department at SQU Hospital. It began as a one-bed unit, which was expanded to two beds in 2000. The program currently has the infrastructure to perform approximately 15 allogeneic transplants per year. We are recent members of the European BMT group. This paper describes the experience of HSCT in the Sultanate of Oman over the past decade. Patients and methods Between June 1995 and August 2006, a total of 128 patients underwent 132 HSCT procedures in this center, the last few years averaging approximately 15 transplants per year. The median age was 11 years, ranging from 44 days to 45 years. Transplant program The transplant unit consists of two transplant beds in positive pressure, high-efficiency particulate air-filtered rooms and two step-down beds in standard isolation rooms. Concomitant with the growth of the clinical transplant program has been the development of state-of- the-art transplant laboratory facilities. The major compo- nents of this include a molecular biology section for chimerism and minimal residual disease analysis, a Clinimax machine for T-cell depletion and a BU pharma- cokinetic laboratory. Ninety-five per cent of patients (121/ 128) transplanted in this center were Omani nationals. HSCTs in Oman were performed for a wide spectrum of disorders as shown in Figures 1 and 2, with a fairly equal proportion of patients with hematologic malignancy and inherited disorders. The major categories of inherited disorders included thalassemia major and primary immu- nodeficiency syndromes. In total, 128 transplants (97%) were allogeneic and four (3%) were autologous (Table 1). We were able to obtain HLA-matched siblings in approxi- mately 40% of our patients. Two patients received T-cell- depleted haplo-identical transplants for SCID syndrome (SCIDS). We currently have a waiting list of more than 100 patients, most of whom have thalassemia. The approximate cost of an uncomplicated allogeneic HSCT here is US$50 000. The Sultan Qaboos University (SQU) has an impressive infrastructure for research, and research grants are made available in both clinical and basic sciences. One of our major research interests in HSCT has been the role of BU pharmacokinetics in transplant conditioning and its relation to chimerism and toxicity. 4,5 We established the oxidative burst assay by flow cytometry in our laboratory for the diagnosis of chronic granulomatous disease (CGD) Correspondence: Dr D Dennison, Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman. E-mail: david_dennison@hotmail.com Bone Marrow Transplantation (2008) 42, S109–S113 & 2008 Macmillan Publishers Limited All rights reserved 0268-3369/08 $30.00 www.nature.com/bmt