Implementation of a Dedicated Hematopoietic Stem Cell Transplant Program for Sickle Cell Disease in Lagos, Nigeria: Challenges and Opportunities

Abstract

Comprehensive strategies are crucial for alleviating the substantial burden of sickle cell disease (SCD) in sub-Saharan Africa. Allogeneic hematopoietic stem cell transplantation (alloHSCT) offers a potentially scalable and cost-effective cure for eligible SCD patients; however, it is currently available in only seven African countries due to difficulties in implementing alloHSCT in Low- and Middle-Income Countries (LMICs). These challenges include limited and underdeveloped healthcare infrastructure, high rates of infectious diseases worsened by emerging multidrug-resistant pathogens, restricted access to effective antimicrobial agents, and the lack of advanced transplant technologies such as T-cell depletion, HLA typing laboratories, and stem cell processing facilities. The shortage of specialized supportive care and trained staff, along with inadequate access to chemotherapeutic and immunosuppressive drugs, further hampers progress. Additionally, there is no health insurance coverage for procedures like HSCT, forcing patients and their families to pay out of pocket, which makes HSCT unaffordable for many who could greatly benefit from it. Government support remains far below what is necessary to expand transplant capacity. For those who can afford it, medical tourism for HSCT outside Africa is increasing. Unfortunately, many of these patients return to environments with limited expertise and resources for post-transplant follow-up care. This article discusses the challenges faced in establishing a dedicated alloHSCT program for SCD at a tertiary hospital in Lagos, Nigeria, and explores opportunities for improvement.