Latin American Training Program

During this 12-week training program, the trainee will conduct all daily clinical activities under the supervision of stem cell transplantation (SCT) staff members. These activities, as well as other program objectives, include:

• Clinical staff meetings for daily inpatient updates (Monday to Friday, 8:00 a.m. to 9:00 a.m.)
• Eight weeks of clinical rounds in the hematology care unit (Monday to Saturday, 9:00 a.m. to 12:00 midnight)
• Four weeks of clinical follow up of discharged outpatients at the daily outpatient clinic (Monday to Friday, 9:00 a.m. to 1:00 p.m.)
• Two SCT clinics per week (Tuesdays at 2:00 p.m. and Thursdays at 10:00 a.m.) for pre-SCT evaluation and long-term follow up of transplanted patients
• Participation in each step of the SCT procedure:
• Stem cell mobilization
• Stem cell timing counts in the flow cytometry laboratory
• Stem cell harvesting by leukapheresis in the blood bank unit
• Cell processing in the cryopreservation unit
• Stem cell infusion
• Active participation in regular scientific meetings (Thursdays at 9:00 a.m.)
• Participation at the weekly SCT staff meeting for discussion, planning, and coordination of SCT procedures (Tuesdays at 11:00 a.m.)
• Interaction with other departments involved in the SCT program, including:
• Stem cell donor registry and HLA laboratory
• Vascular surgery
• Blood bank unit and cytapheresis laboratory
• Nutritional support unit
• Infectious diseases unit
• Psycosocial medicine unit
• Training in quality management and application of quality model procedures
• Interaction with medical staff on duty in the hematology care unit twice a week
• Interaction with “Fundación PORSALEU.” Since 2001, this volunteer foundation has provided housing and social support for outpatients and their families coming from outside the city to receive treatment (www.porsaleu.org)
• Interaction with the department director and SCT staff in terms of applicability of the project at the home institution, setting up a transplant program, increasing capacities progressively, and overcoming difficulties
• Interaction with the hospital director who supports and promotes this action

Eligibility Requirements

• You must represent an institution that currently operates an SCT unit or department or is in the process of developing one and has the capabilities to implement the necessary procedures.
• You must present a support letter from your home institution, signed by your supervisor and relevant department head (hematology, SCT department), if applicable, that verifies support of leave for training and confirms that the required equipment is available to implement the training.
• You must meet all other eligibility requirements listed at the top of the LATP application.

Non-Portuguese speaking candidates may apply.

This 12-week program covers the diagnosis and treatment of a wide range of coagulopathies, including hemophilia, von Willebrand disease, rare factor deficiencies and platelet disorders, and hereditary thrombopathies. The primary objectives of this program include understanding the principle clinical complications for these disorders; organizing a system for immediate treatment of hemorrhagic episodes; and laboratory diagnosis of hemophilia, von Willebrand disease, and other coagulopathies.

Training Program Schedule

• Week 1: Congenital coagulopathies outpatient follow-up care
• Weeks 1-12: Participation at multidisciplinary rounds for congenital coagulopathies
• Weeks 2-3: Immediate care and coagulation factor infusion in the emergency room, with hemorrhagic or other disease-related complications
• Week 4: First screening and evaluation of suspected cases for diagnosis confirmation
• Week 5: Participation in patient training and education, including self-infusion
• Week 6: Training on organization of dentistry and physical therapy care focused on coagulopathies
• Weeks 8-9: Training on storing and distributing coagulation factors concentrates, including traceability
• Weeks 10-12:Training at the coagulation reference lab

Non-Portuguese speaking candidates may apply.

Participants of this 12-week training program receive hands-on training in flow cytometry and molecular biology techniques for the diagnosis of hematologic malignancies. Trainees also attend weekly meetings to discuss the findings of morphological, immunophenotypic, genetic, and histopathological analysis of cases sent to the Ribeirão Preto Medical School’s hematology lab.

The following topics are covered during the program:

Flow Cytometry

• Lab safety and sample handling
• Mononuclear cell isolation using Ficoll Hypaque gradient and whole-blood lysis
• Frequently used monoclonal antibody panels and relevant controls in daily practice
• Data acquisition
• Setting the signal intensity and threshold of the cytometers
• Setting regions and gates
• Analysis of lymphoproliferative diseases
• Analysis of acute myeloid leukemia and myelodysplastic syndromes
• Analysis of acute lymphocytic leukemia
• Analysis of multiple myeloma
• Analysis of paroxysmal nocturnal hemoglobinuria
• Discussion of cases of minimal residual disease analysis in acute leukemias

Molecular Biology Techniques

• DNA and RNA extraction and quantification
• Quality control of oligonucleotide samples
• Agarose gel preparation
• cDNA synthesis
• RT-PCR technique for PML/RARa, CBFbeta/MYH11, RUNX1/RUNX1T1 and FLT3-ITD detection
• RQ-PCR technique for PML/RARa
• RQ-PCR technique for JAK2 V617F mutations
• RQ-PCR for cyclin D1 quantification

Eligibility Requirements

• You must represent an institution that currently owns and operates a flow cytometer.
• You must present a support letter from your home institution, signed by your supervisor, that verifies support of leave for training and confirms that the required equipment is available.
• You must meet all other eligibility requirements listed at the top of the LATP application.

This 12-week training program consists of hands-on activities in the flow cytometry and molecular biology lab for the diagnosis and follow up of hematologic diseases. Trainees attend weekly case discussion meetings in the hematology department and surgical pathology lab and participate in the journal club and seminars.

The following topics are covered during the program:

Flow Cytometry

• Lab safety and sample handling
• Euroflow standard operating procedure and panels
• Data acquisition
• Setting the signal intensity and threshold of the cytometers
• Setting regions and gates
• Analysis of lymphoproliferative diseases
• Analysis of acute myeloid leukemia (AML) and myelodysplastic syndromes
• Analysis of acute lymphocytic leukemia (ALL)
• Analysis of multiple myeloma (MM)
• Analysis of paroxysmal nocturnal hemoglobinuria
• Analysis of spherocytosis
• Minimal residual disease analysis for AML, ALL, and MM
• FISH techniques

Molecular Biology Techniques

• Lab safety and sample handling
• DNA and RNA extraction and quantification
• Quality control of oligonucleotide samples
• Agarose gel preparation
• Capillary electrophoresis
• Qualitative and quantitative RQ-PCR for BCR/ABL and PML/RAR alfa
• JAK2 V617F mutations by ARMS-PCR and RQ-PCR
• RT-PCR for FLT3-ITD TKD, NMP1, CEBPA, EXON 12, CALR, MPL, MYD88
• Sanger fragment analysis
• T and B cell clonalty by PCR-sequencing
• Interpretation and analysis of raw data and result reporting
• Quality management program

Eligibility Requirements

• You must comply with the rotations requirements of the Training and Research Program at the Hospital Italiano de Buenos Aires. This includes submitting the following:
  • Rotation application form, signed by your supervisor, that verifies support of leave for training
  • Copy of ID or passport
  • Certificate of residency stating your current year of residency (only for applicants in training at their home institutions)
  • Copy of your university degree and brief resume (only for health professionals not currently in training at their home institutions)
  • Hepatitis B vaccination certificate
  • Copy of Health and Hospital Accident Insurance valid in Argentina, issued by an insurance company or labor risk insurer in dollars (can be acquired at the Hospital Italiano de Buenos Aires)

• You must meet all other eligibility requirements listed at the top of the LATP application.

This 12-week program focuses on laboratory practices and interpretation of flow cytometry and molecular biology tests for diagnosis, prognosis, and the evaluation of treatment effectiveness during hematologic disorder follow-ups.

Through didactic lecture presentations, case study discussions, and hands-on laboratory work, trainees will learn to understand practice issues involved in flow cytometry and molecular diagnostics for hematologic disorders. There will be opportunities to discuss the diagnostic work-up in each disease type with academic staff, attend a weekly hematology department meeting, and follow up with patients diagnosed in the flow cytometry and molecular biology lab.

During flow cytometry training, candidates will participate in the triage of new cases that arrive in the lab. They will follow up on procedures and protocols to solve the cases and assist faculty as they analyze and report on the cases. During the molecular biology training, candidates will learn how to perform basic molecular techniques and will become familiar with the molecular testing used in hematopathology. For each molecular test, the trainees will learn about appropriate test utilization, limitations of techniques, and final interpretations.

Specific Activities for Each Week

• Week 1: Procedures and protocols used in the flow cytometry lab and the instrument set up
  • Daily QC and standardization procedure using CS&T and rainbow beads
  • Flow cytometer operation sample acquisition
  • Sample triage and antibody panel selection according to clinical data
  • Sample preparation: protocols for blood and BM, cerebrovascular fluid, FNA samples, tissues biopsies
  • Data display, storage, and transfer
  • Data analysis and gating
  • Surface and intracellular staining protocols; bulk lysis protocols
• Week 2: Acute myeloid leukemia (AML)
  • Recognizing normal in myeloid differentiation in bone marrow
  • Diagnostic work-up for AML
  • Acute myeloid leukemia immunophenotyping; diagnosis and minimal residual disease
  • Myelodysplastic syndromes; score systems
• Week 3: Acute lymphoid leukemia (ALL)
  • Recognizing normal in lymphoid differentiation in bone marrow and lymph nodes
  • ALL: immunophenotyping for diagnosis and minimal residual disease
  • Diagnostic work-up for ALL
• Week 4-5: B, T, and NK chronic lymphoid disorders
  • Screening for mature lymphoid disorders; differential diagnosis
  • Minimal residual disease for chronic lymphocytic leukemia
  • Paucicellular samples; cerebrospinal fluid analysis for detection blasts and lymphoma cells

• Week 6: Plasma cell disorders (MGUS, myeloma, and Waldestrom macroglobulinemia)
  • Screening for plasma cell disorders
  • Minimal residual disease for myeloma; concept of next-generation flow
• Week 7: Research module
  • Immune cell subsets in peripheral blood, intracellular cytokine detection, bead-based immunoassays
  • Endothelial progenitor cells and circulating endothelial cells
• Week 8: Orientation of the molecular laboratory
  • Hands-on activity: DNA and RNA extraction; quantification (agarose gel preparation, overview of PCR and variants)
  • Protocols and procedures: PCR/RFLP and allele-specific PCR
  • Thrombophilia testing: FV Leiden and FII 20210A
• Week 9: Protocols and procedures: Mutation analysis using amplicon sizing by capillary electrophoresis and fragment length analysis
  • Molecular tests for diagnosis and prognosis assessment in chronic myeloproliferative disorders: BCR-ABL t(9;22), JAK2-V617F, JAK2-Exón 12, Calreticuline (CALR), MPL, ABL-T315, c-KIT-D816V
  • Molecular testing algorithm for myeloproliferative neoplasms
• Week 10: Protocols and procedures: Sequencing analysis
  • Molecular tests for diagnosis and prognosis assessment in acute myeloid and lymphoid leukemia: PML-RARα, BCR-ABL FLT3-D835, FLT3-ITD, FLT3-ITD ratio, NPM1 mutations, CEBPA, RUNX1, ASXL1, P53
  • Molecular testing algorithm for acute leukemias

• Week 11: Protocols and procedures: RQ PCR
  • Molecular tests for treatment response assessment in chronic myeloid leukemia: BCR-ABL t(9;22) by Q-RTPCR
• Week 12: Molecular testing in other molecular laboratories; diagnostic tests for infectious diseases and solid tumors

Eligibility Requirements

• You must represent an institution that currently owns and operates a flow cytometer.
• You must present a support letter from your home institution, signed by your supervisor, that verifies support of leave for training and confirms that the required equipment is available.
• You must meet all other eligibility requirements listed at the top of the LATP application.

This 12-week program will focus primarily on the histopathologic diagnosis of benign and malignant diseases of the hematopoietic and lymphoid systems.

Through daily sign-out of biopsies, the candidate will get exposure to the most common benign and neoplastic conditions. The candidate will understand the basics and diagnostic criteria for the classification scheme of hematopoietic and lymphoid systems disorders/neoplasms and will formulate differential diagnoses of hematopoietic and lymphoid disorders, through the correlation and interpretation of morphology, clinical data, and relevant phenotypic/genotypic ancillary studies.

The candidate will learn the fundamentals of interpretation of ancillary techniques including immunohistochemistry technology, flow cytometry and molecular diagnostic assays (PCR, in situ hybridization, conventional cytogenetics procedures, and fluorescent in situ hybridization (FISH)). They will learn the applications and interpretation of these tests in the diagnosis of hematopoietic and lymphoid lesions and will discuss the use of these assays in the diagnosis, correlate data with histologic findings, and describe the decisions involved in test selection.

The candidate will have weekly didactic lecture presentations, journal club, case study presentations, and discussions, where he/she will learn to understand practice issues involved in the histopathologic diagnosis of hematolymphoid disorders. The candidate will have the opportunity to discuss the diagnostic work-up in each disease type with the program coordinator and academic staff, attend a weekly hematology and pathology department meeting, and follow up of patients diagnosed in the Anatomic Pathology Department.

Specific Activities for Each Week

• Week 1: Immunohistochemistry Laboratory
  • Daily QC and standardization of immunohistochemistry assays
  • Learn the basic principles of immunohistochemistry assays
  • Learn the basic principles of adequate tissue fixation for immunohistochemical analysis
  • Interpretation of positive and negative results, and primary artifacts
  • Antibody panel selection according to clinical data Know the prognostic value of some antibodies for clinical management

• Week 2: Normal bone marrow and reactive conditions
  • Recognize normal myeloid and lymphoid differentiation in bone marrow
  • Morphologic assessment of peripheral blood smear (PBS) evaluation
  • Morphologic assessment of bone marrow aspirate smear (BMA) and biopsy
  • Recognize the most common morphologic abnormalities of non-neoplastic conditions in PBS, BMA and biopsy
  • Journal club

• Week 3: Myeloproliferative neoplasms (MPN)
  • Recognize the most common MPN
  • Learn the current World Health Organization (WHO) classification of MPN
  • Diagnostic work-up for NMP
  • Morphologic evaluation of PBS, BMA and biopsy
  • Integration of clinical data, pathologic findings and ancillary studies
  • Case presentation and discussion with academic staff of Hematology and Anatomic Pathology Departments
  • Journal club

• Week 4: Myelodysplastic syndromes (MDS)
  • Recognize the most common MDS
  • Learn the current WHO classification of MDS
  • Diagnostic work-up for MDS
  • Morphologic evaluation of PBS, BMA and biopsy
  • Integration of clinical data, pathologic findings and ancillary studies
  • Recognize the important cytogenetic and molecular abnormalities in MDS
  • Case presentation and discussion with academic staff of Hematology and Anatomic Pathology Departments
  • Journal club

• Week 5: Acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL)
  • Recognizing normal in myeloid and lymphoid differentiation in bone marrow
  • Recognize to most common AML and ALL
  • Learn the current WHO classification of AML and ALL
  • Diagnostic work-up for AML and ALL
  • Morphologic evaluation of PBS, BMA and biopsy
  • Integration of clinical data, pathologic findings and ancillary studies
  • Recognize the important cytogenetic and molecular abnormalities in AML and ALL
  • Case presentation and discussion with academic staff of Hematology and Anatomic Pathology Departments
  • Journal club

• Week 6: Normal histology and reactive conditions of lymph node (LN), spleen, thymus and extranodal sites (ES)
  • Perform adequate macroscopic evaluation of LN, spleen, thymus and ES tissue specimens
  • Recognize the most common non-neoplastic conditions in LN, spleen, thymus and ES
  • Morphologic assessment of LN, spleen, thymus and ES biopsies
  • Recognize the histopathologic patterns of reactive conditions
  • Recognize the basic histopathologic patterns of reactive versus neoplastic conditions, and recognition of mimickers
  • Journal club

• Week 7: Mature B-cell and Plasma cell neoplasms
  • Recognize the most common mature B-cell and plasma cell neoplasms
  • Learn the current WHO classification of mature B-cell and plasma cell neoplasms
  • Diagnostic work-up for mature B-cell and plasma cell neoplasms
  • Morphologic evaluation of LN, spleen, thymus and ES tissue specimens
  • Integration of clinical data, pathologic findings and ancillary studies
  • Recognize the important cytogenetic and molecular abnormalities mature B-cell and plasma cell neoplasms
  • Case presentation and discussion with academic staff of Hematology and Anatomic Pathology Departments
  • Journal club

• Week 8: Mature T-cell neoplasms
  • Recognize to most common mature T-cell neoplasms
  • Learn the current WHO classification of mature T-cell neoplasms
  • Diagnostic work-up for mature T-cell neoplasms
  • Morphologic evaluation of LN, spleen, thymus and ES tissue specimens
  • Integration of clinical data, pathologic findings and ancillary studies
  • Recognize the important cytogenetic and molecular abnormalities mature T-cell neoplasms
  • Case presentation and discussion with academic staff of Hematology and Anatomic Pathology Departments
  • Journal club

Week 9: Hodgkin Lymphoma (HL) and immunodeficiency-associated lymphoproliferative disorders (IALPD)
• Recognize to different types of HL and IALPD
• Learn the current WHO classification of HL and IALP
• Diagnostic work-up for HL and IALPD
• Morphologic evaluation of LN, spleen, thymus and ES tissue specimens
• Integration of clinical data, pathologic findings and ancillary studies
• Recognize the important molecular abnormalities in HL and IALPD
• Case presentation and discussion with academic staff of Hematology and Anatomic Pathology Departments
• Journal club

Week 10: Histiocytic and dendritic cell disorders/neoplasms
• Recognize to most common non-neoplastic histiocytic and dendritic cell disorders
• Learn the current WHO classification of histiocytic and dendritic cell neoplasms
• Diagnostic work-up for histiocytic and dendritic cell disorders/neoplasms
• Morphologic evaluation of LN, spleen, thymus and ES tissue specimens
• Integration of clinical data, pathologic findings and ancillary studies
• Recognize the important molecular abnormalities in histiocytic and dendritic cell neoplasms
• Case presentation and discussion with academic staff of Hematology and Anatomic Pathology Departments
• Journal club

• Week 11: Flow cytometry
  • Introduction to flow cytometry and fundamentals of clinical indications
  • Learn the principles of flow cytometry and sample preparation
  • Diagnostic work-up for hematolymphoid disorders
  • Understand the principle of cellular sub-populations analysis
  • Learn the basic principles for the diagnosis of minimal residual disease
  • Integration of results with clinical and pathologic findings
  • Case presentation and discussion with academic staff of Hematology and Anatomic Pathology Departments
  • Journal club

• Week 12: Cytogenetics and molecular biology
  • Introduction to basic principles of cytogenetics and molecular biology
  • Recognize human chromosomes and nomenclature
  • Recognize the most common cytogenetic abnormalities in hematolymphoid neoplasms
  • Learn the fundamentals of PCR, in situ hybridization and FISH
  • Learn the process of DNA extraction
  • Perform a molecular test (PCR, FISH)
  • Integration of results with clinical and pathologic findings
  • Case presentation and discussion with academic staff of Hematology and Anatomic Pathology Departments
  • Journal club

This 12-week program is intended for pediatric hemato-oncologists who are involved in the care of transplanted patients or are developing new transplant programs. The daily activities under hematopoietic stem cell transplantation (HSCT) staff supervision will take place from 8:00 a.m to 5:00 p.m. Trainees will be exposed to the three major transplantation areas: pre-transplant, transplant procedure, and post-transplant follow up. Trainees will have also the opportunity to discuss administrative issues with the staff.

BMT Unit Rounds

• General round including medical staff, shift nurses, head nurses, education nurse, clinical pharmacist, social worker, psychologist (Mondays at 8:15 a.m. and Fridays at 12:30 p.m.)
• Medical in-patient staff, trainee, fellows (Tuesday to Friday at 8:15 a.m.)
• General round including medical staff, shift nurses, head nurses, clinical pharmacist (Monday to Thursday at 12:30 p.m.)
• Medical in-patient staff, trainee, fellows and pediatrics residents (Monday to Friday at 4:00 p.m.)

Patient Meetings

• Pre-transplantation round (Monday afternoons)
• Post-transplantation round (Wednesday afternoons)
• HLA and new patient review (Thursday afternoons)

General Meetings

• Pediatrics Department general round (Wednesday mornings)
• Oncology-Hematology-BMT meeting (Friday mornings)

Weekly Schedule

• Weeks 1-4: Pre-transplantation clinic and administrative issues
• Pre-transplantation clinic:
• HSCT indications review
• General candidates list
• Patients summary review
• HLA review, donor selection, stem cell sources
• Clinical evaluation according to specific disease and HSCT protocols
• Laboratory evaluation according to specific disease and HSCT protocols
• Pre-transplantation evaluation planning: BM back-up, radiotherapy, conditioning regimen, CVC, final admission
• Administrative issues:
• BMT unit general structure
• Physical requirements
• Budget resources
• Human resources
• Hospital network: laboratories, assistant services, and departments (radiology, pharmacy, hematology, blood bank, etc.)
• Planning and development
• Evaluation schedule
• Accreditation
• Weeks 5-8: In-patient clinic
• HSCT indications review
• Patients summary review
• Clinical evaluation according to specific disease and HSCT protocols
• Laboratory evaluation according to specific disease and HSCT protocols
• Transplantation planning: BM back-up, radiotherapy, conditioning regimen (myeloablative and RIC), immunosuppression, CVC
• Complications: infectious complications, mucositis, pain, GvHD (diagnosis, scoring, staging, and treatment), others (VOD, TMA, hemorrhagic cystitis, etc.)
• Infusions and treatments: IVIG, antibiotics, antivirals, transfusions, hydration
• Follow-up and therapeutic procedures: lumbar puncture, bone marrow aspirate and harvest and procurement, donor lymphocyte, and HSCT infusions
• Laboratory procedures: stem cell apheresis, processing techniques (management of ABO incompatibilities, CB thawing, PB progenitors freezing and thawing, ex vivo TC depletion)
• Weeks 9-12: Post-transplantation outpatient clinic
• Early post-transplantation follow-up (3 weeks)
• Clinical evaluation according to specific disease and HSCT protocols
• Laboratory evaluation according to specific disease and HSCT protocols
• Infectious complications
• Immunological complications/GvHD screening, scoring, and treatment
• Acute readmissions
• Daily infusions and treatments: IVIG, antibiotics, antivirals, transfusions, hydration
• Follow-up and therapeutic procedures: lumbar puncture, bone marrow aspirate, donor lymphocyte infusions
• Long-term post-transplantation follow-up (1 week)
• Clinical evaluation according to specific disease and HSCT protocols
• Laboratory evaluation according to specific disease and HSCT protocols
• Infectious complications
• Immunological complications/GvHD screening, scoring, and treatment
• Long-term complications: endocrinological, metabolic, cardiovascular, respiratory, ophthalmological
• Immune reconstitution and vaccination schedule
• Social, family psychological evaluation
• Transference to local health network

Eligibility Requirements

• You must come from an institution that currently has an SCT unit or is in the process of developing one.
• You must be able to provide the following paperwork:
• A support letter from the director of your home institution, which specifies support for leave for training.
• Curriculum vitae
• Hepatitis B vaccine certification
• International health insurance certificate
• Valid professional certification
• You must meet all other eligibility requirements listed at the top of the LATP application.
• Successful candidates will be put in contact with the hospital academic department (UCAD) for further information and regulations according to international agreements from Chile and the applicant's home country.

This 12-week program focuses on training for all phases of management of pediatric patients undergoing hematopoietic stem cell transplantation (HSCT). Trainees will learn the clinical and laboratory aspects of SCT necessary for the treatment of children. This program is designed for pediatric hemato-oncolologists or pediatric immunologists. Activities are scheduled from 7:00 a.m. to 7:00 p.m., Monday through Friday, and Saturdays from 8:00 a.m. to 2:00 p.m.

This program will feature the following components:

Didactic Education

• Daily clinical rounds in the bone marrow unit with in-patients (7:00 a.m. to 9:00 a.m.)
• Attendance at outpatient services Monday through Thursday (accompanied by a training supervisor) from 10:00 a.m. to 12:00 noon
• Patient review conferences (daily at 2:00 p.m.)
• Weekly fellow conference (Fridays at 8:00 p.m.)
• Cure4Kids conference with Mexican SCT group (every other Friday at 9:00 a.m.)
• Weekly tumor board conference (Fridays at 12:00 noon)
• Weekly journal club (Wednesdays at 12:30 p.m.) and monthly research meeting (4th Tuesday of the month at 3:30 p.m.)
• Visit to the Blood Center and Cell Therapy Laboratory
• Quality standard session review weekly (Fridays at 10:00 a.m.)

Training Schedule

Week 1

• Learn the biological features of hematopoietic stem cells (marrow, cord blood, or blood derived) and their mobilization/collection.
• Learn how human HLA antigens guide selection of allogeneic stem cell transplant donors

Week 2

• Learn how to manage stem cell infusions (bone marrow, cord blood, peripheral blood; thawing cord blood or peripheral blood)
• Understand the pathophysiology and management of graft rejection
• Learn how chimerism is utilized in the management of allogeneic HSCT (particularly in reduced intensity conditioning patients)

Week 3

• Learn how to assess immune recovery of HSCT
• Diagnosis and treatment of infections early and their relationship with immune reconstitution

Week 4

• Management of patient from time of referral through initial consultation and decision(s) regarding type of transplant and conditioning/stem cell source
• Coordination with referring physician and overseeing pre-HSCT evaluations.
• Assessment of patients referred for HSCT and discussion of the procedure with the patient/family

Week 5

• Learn the indications for autologous versus allogeneic HSCT
• Learn how to manage patients receiving high-dose chemotherapy and complications related to of mucositis, neutropenic fever, and the need for blood product support

Week 6

• Diagnosis and treatment of acute infections and relationship with immune reconstitution of the patient.

Week 7

• Learn the features and pathophysiology of acute graft-versus-host disease (GvHD)
• Manage patients presenting with acute GvHD: assessment, appropriate biopsies, and therapeutic plan

Week 8

• Learn the features and pathophysiology of chronic GvHD
• Management of patients presenting with chronic GvHD: assessment, appropriate biopsies, and therapeutic plan

Week 9

• Learn the indications for reduced intensity allogeneic HSCT
• Learn the types of Haploidentical Transplant with Cyclophosphamide and immuno-selection

Week 10

• Follow-up of patients in the long term
• Implementation of a quality program according to the FACT standards
• Participate in marrow harvests and observe the preparation of the stem cell product in the stem cell laboratory

Week 11

• Develop a hypothesis for a research project, review background publications, and develop research plan
• Review appropriate data sources, collect and collate data, initiate assessment, and consider appropriateness/feasibility of plan

Week 12

• Complete data collection, extend analysis of data, and present preliminary findings to HSCT team
• Formalize presentation of data, conclusions, and prepare manuscript related to project

Eligibility Requirements

• You must be a pediatric hemato-oncologist or immunologist with an interest in developing or extending services for HSCT in your own institution.
• You must come from an institution that currently has an SCT unit or is in process of developing one.
• You must provide your curriculum vitae with a copy of professional certification.
• You must present international health insurance.
• You must comply with the immigration requirements to enter Mexico.
• You must meet all other eligibility requirements listed at the top of the LATP application.

This 12-week program focuses on laboratory practices and test interpretation involved in the diagnosis of thrombosis and hemostasis disorders. Training areas include basic and advanced clotting tests, laboratory diagnosis of Von Willebrand Disease (VWD) phenotypes, platelet function testing, and thrombophilia diagnosis.

Training Program Schedule

• Week 1: Global laboratory function, theoretical updating on hemostasis process, including platelet function, clotting and fibrinolytic systems, and natural anticoagulants.
• Weeks 2-4: Basic clotting tests, preparation of plasma pool control, quantification of clotting factors, screening, and identification of antibodies. Laboratory control of heparin and new anticoagulant drugs. Pre-analytical and analytical controls. Report of results. Internal and external quality control processes.
• Weeks 5-6: Training in VWD testing and diagnosis: VWF:Ag, VWF:RCo, VWF:CB, RIPA, FVIII binding to VWF, multimeric analysis of VWF, ADAMTS 13 assay. Laboratory diagnostic criterium.
• Weeks 7-9: Training in platelet function testing: platelet aggregation and serotonin secretion, including diagnostic criteria; platelet procoagulant activity, detection of anti-platelet antibodies, diagnosis of platelet glycoprotein deficiencies, and platelet compatibility testing by flow cytometry.
• Weeks 10-12: Inherited and acquired thrombophilia diagnosis: measurements of antithrombin and protein C by functional (coagulometric assay) and antigenic (ELISA assay); protein S antigen (ELISA), activated protein C resistance (coagulometric assay), diagnosis of FV Leiden and prothrombin C20210A mutation (PCR, lupus anticoagulant screening), and confirmation assays. HIS diagnosis: anti-heparin-PF4 antibodies and serotonin release assay (by HPLC).

Trainees also attend weekly bibliography and research meetings as well as meetings to review, analyze, and interpret all tests performed on Wednesday and Friday each week. Trainees are asked to give a final seminar at the end of their stay.

If the trainee is a physician, he/she will have the chance to attend in- and out-patient specialized clinical practice and out-patient anticoagulant clinic during his/her last six weeks stay. During his/her entire stay, training supervisors explore realistic avenues of collaboration and continued improvement with the trainee and his/her home institution.

Eligibility Requirements

• You must accredit a title of MD, PhD, biochemist, or laboratory technician.
• You must direct or work in a diagnostic or research thrombosis and hemostasis laboratory or in the thrombosis and hemostasis section of a clinical laboratory at your hospital. The laboratory must be equipped with automatic coagulometers and ELISA facilities. If not available, your institution must commit to develop, in their center, the study of platelet aggregometry and the molecular diagnosis of Factor V Leiden and G20210A prothrombin mutation.
• You may get additional benefits if you have access to flow cytometry and molecular diagnosis at your home Institution.
• You must meet all other eligibility requirements listed at the top of the LATP application.