David Gómez-Almaguer

Background Autologous hematopoietic stem cell transplantation (AHSCT) is an immune-reconstitution strategy for selected patients with multiple sclerosis (MS). Large real-world studies with long-term disability assessments remain limited. Objective To evaluate longitudinal changes in Expanded Disability Status Scale (EDSS) scores after AHSCT and to determine the proportions of patients achieving clinically meaningful improvement, stability, or progression. Materials and Methods This retrospective longitudinal cohort included 1,657 patients with MS who underwent AHSCT within HSCT México, a single clinical program operating at sites in Puebla and Monterrey, Mexico, between November 2012 and July 2026. Baseline EDSS scores were assigned by a neurologist. At follow-up, EDSS scores were obtained from a neurologist assessment when available and when a neurologist-assigned EDSS was not available, the score was derived using a structured EDSS calculator during the scheduled follow-up assessment. Clinically meaningful improvement was defined as a decrease of at least 1.0 EDSS point, progression as an increase of at least 1.0 point, and stability as a change of less than 1.0 point in either direction. Outcomes were also examined according to relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), and primary progressive MS (PPMS) phenotypes. Results Complete baseline–follow-up EDSS pairs were available for 675 patients at 3 months (40.7%), 549 at 6 months (33.1%), 578 at 12 months (34.9%), 350 at 18 months (21.1%), 361 at 24 months (21.8%), 245 at 36 months (14.8%), and 106 at 60 months (6.4%). Mean EDSS decreased significantly at 3 months (mean change, -0.18; 95% CI, -0.26 to -0.0; p < 0.001), 6 months (-0.16; 95% CI, -0.26 to -0.06; p = 0.001), 12 months (-0.36; 95% CI, -0.47 to -0.26; p < 0.001), 18 months (-0.24; 95% CI, -0.39 to -0.09; p = 0.002), and 24 months (-0.25; 95% CI, -0.40 to -0.10; p = 0.001). No significant differences from baseline were observed at 36 months (-0.13; 95% CI, -0.32 to 0.05; p = 0.144 ) or 60 months (0.02; 95% CI, -0.31 to 0.35; p = 0.910). Wilcoxon analyses yielded concordant findings, with the largest nonparametric effect observed at 12 months (r = 0.334). At 12 months, 27.2% of patients improved, 62.5% remained stable, and 10.4% progressed. At 60 months, 26.4% improved, 48.1% remained stable, and 25.5% progressed; thus, 74.5% of patients with long-term paired data have remained stable or improved. Conclusions AHSCT was associated with significant reductions in EDSS through 60 months, with the greatest improvement observed at 12 months; most patients with available long-term data remained stable or improved.

Purpose: The integration of diagnostic tools, immunochemotherapy, targeted agents, and cellular therapies such as chimeric antigen receptor T-cell therapy (CAR-T) cells has transformed lymphoma outcomes in high-income countries. However, in Latin America (LATAM), access to these advances remains limited. This study aimed to assess lymphoma care access and institutional capacity in LATAM. Methods: We conducted a cross-sectional digital survey from July 2025 to August 2025, coordinated by the Grupo de Estudio Latinoamericano de Linfoproliferativos network. The survey captured center-level data covering infrastructure, human resources, diagnostic and therapeutic availability, and clinical research activity. Data were analyzed using descriptive methods. Results: A total of 73 hematology centers from 16 Latin American countries completed the survey. Most centers were public institutions (53%), with a median number of four hematologists per center (range, 2-10). While basic pathology and flow cytometry were widely available, access to advanced diagnostics was limited. Fifteen centers (21%) lacked immunohistochemistry, and pathology turnaround times exceeded 3 weeks in 56%. Positron emission tomography-computed tomography was available in 41% of centers. Novel therapies such as antibody-drug conjugates, bispecific antibodies, and checkpoint inhibitors were not available or restricted in most centers. Hematopoietic stem-cell transplantation was performed in 41% of centers, whereas commercial CAR-T was available in 5%. Clinical trials were conducted in 34% of centers. Conclusion: Our findings highlight striking disparities between guideline-recommended lymphoma care and real-world institutional capacity across LATAM, underscoring the importance of collaborative efforts in building capacity and advocating for equitable access.

Chimeric antigen receptor T-cell (CAR-T) therapy has emerged as a transformative treatment for patients with relapsed or refractory hematologic malignancies, offering new possibilities beyond conventional transplantation. Since their approval in high-income countries, CAR-T products have demonstrated remarkable efficacy; however, their implementation in low- and middle-income countries (LMICs) remains limited due insufficient infrastructure, complex regulatory requirements and high costs. In some countries, like Mexico, these barriers are particularly pronounced, with limited access to clinical-grade vectors, early phase clinical research programs, and lack of government and private sector infrastructure and funding opportunities. Facing these challenges, there is a substantial patient population with B-cell acute lymphoblastic leukemia, multiple myeloma, or diffuse large B-cell lymphoma, who could benefit from CAR-T therapy. Advances in point-of-care manufacturing within academic settings –particularly the use of closed, semi-automated systems– have demonstrated feasibility in LMICs, by reducing costs and simplifying procedures, while maintaining product quality. These approaches may provide a viable alternative to commercial products, with the potential to lower the economic burden and increase accessibility. Regulatory innovation with the establishment of expert multidisciplinary oversight committees, will also be critical to ensure safe implementation. Ultimately, CAR-T therapy in LMICs is both a scientific and public health opportunity, and its integration into healthcare systems will depend on collaborative strategies that address financial, logistical, and policy barriers. By highlighting our experience, this review underscores the importance of developing locally adapted solutions to expand access to advanced cellular therapies in resource-constrained settings.