St David’s Day 2023 marks the 40th anniversary of the first stem cell transplant being performed in Wales on 1st March 1983.  This was in a young woman suffering from chronic myeloid leukaemia which, at that time, was the most common reason for having an allogeneic (donor) stem cell transplant since potentially curative alternative therapies available today were unavailable then.  This landmark achievement was performed using a sibling donor and less than two years later, the first unrelated donor transplant was performed in January 1985, again for a patient with chronic myeloid leukaemia.  Other developments quickly followed with the first paediatric transplant being performed at Llandough Hospital in 1986 and the first transplant being performed in Swansea at Singleton Hospital in 1997.  The paediatric transplant programme moved to the UHW site in 2005 following the opening of the Children’s Hospital for Wales.

All of the clinical units were supported by collection and processing facilities on the UHW site and on 31 August 2011, following a period of harmonisation, all of the programmes merged and adopted the name of the South Wales Blood and Marrow Transplant (SWBMT) Programme.  The name reflected the fact that stem cells were no longer mainly collected directly from the bone marrow but, in the majority of cases, from the peripheral blood, after stimulation of the marrow with a cytokine (chemical) called G-CSF or granulocyte colony stimulating factor.  The SWBMT Programme serves six of the seven Welsh Health Boards (all bar Betsi Cadwaladr UHB) equating to approximately 80% of the Welsh population.

Other significant milestones over the past four decades include the use of reduced intensity conditioning chemotherapy leading up to the transplant which made it possible to raise the upper age limit from 45-50 years to patients in their mid-70s; increasing use of unrelated donors (who now account for approximately 75% of allogeneic transplants) since only 20-30% of patients who need a donor would find a match within their family.  We are indebted to the Welsh Bone Marrow Donor Registry (WBMDR) who finds donors for Welsh patients and the Welsh Transplantation and Immunogenetics Laboratory (WTAIL) who perform the complicated tissue (HLA) typing to ensure that as good a match as possible is found.  Both the WBMDR and the WTAIL are housed by the Welsh Blood Service, an important partner for the SWBMT Programme.

In December 2018 the SWBMT Programme was qualified as a CAR-T centre to deliver an exciting new therapy whereby a patient’s own immune cells are genetically modified to recognise and kill cancer cells.  Delivery of CAR-T treatment began in 2019 and the landscape suggests that this treatment will be delivered to increasing numbers of patients in the coming years.  The Programme is accredited by JACIE, an independent international organisation that accredits transplant programmes in Europe together with its partner organisation FACT, that accredits to the same standards in North America.  In addition, the Programme is licensed by the Human Tissue Authority to ensure that legally-binding quality and safety standards are met.

The SWBMT Programme has a very active research and development portfolio to support its clinical activity and notable achievements include membership and funding from IMPACT, a UK consortium of transplant programmes dedicated to delivering fast-tracked transplant trials; and membership and funding from the Cardiff Experimental Cancer Medicine Centre, funded by CRUK and the UK governmental research funding bodies to deliver early-phase trials for cancer patients.  Members of the SWBMT Programme also played key roles in the successful bid by the Midlands-Wales Advanced Therapies Treatment Centre (ATTC) in being selected as one of only three UK centres to be granted ATTC status by the UK government and in the formation of Advanced Therapies Wales, one of four Welsh Government Precision Medicine pillars, dedicated to bringing novel advanced therapies to the population of Wales.  In 2020 the Wales Cellular Therapy Consortium was founded to coordinate the research activities of the SWBMT Programme.

There will be a celebratory event marking this important milestone of 40 years of service later in the year.

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