Hematopoietic Stem Cell Transplantation

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BlankHematopoietic Stem Cell Transplantation

A Global Perspective

Alois Gratwohl, MD; Helen Baldomero, BMS; Mahmoud Aljurf, MD; Marcelo C.

Pasquini, MD; Bouzas, MD; Ayami Yoshimi, MD; Jeff Szer, MD; Jeff

Lipton, MD; Alvin Schwendener, MA; Gratwohl, PhD; Karl Frauendorfer,

PhD; Dietger Niederwieser, MD; Horowitz, MD; Yoshihisa Kodera, MD; for the

Worldwide Network of Blood and Marrow Transplantation

JAMA. 2010;303(16):1617-1624.

Context Hematopoietic stem cell transplantation (HSCT) requires significant

infrastructure. Little is known about HSCT use and the factors associated with

it on a global level.

Objectives To determine current use of HSCT to assess differences in its

application and to explore associations of macroeconomic factors with transplant

rates on a global level.

Design, Setting, and Patients Retrospective survey study of patients receiving

allogeneic and autologous HSCTs for 2006 collected by 1327 centers in 71

participating countries of the Worldwide Network for Blood and Marrow

Transplantation. The regional areas used herein are (1) the Americas (the

corresponding World Health Organization regions are North and South America);

(2) Asia (Southeast Asia and the Western Pacific Region, which includes

Australia and New Zealand); (3) Europe (includes Turkey and Israel); and (4) the

Eastern Mediterranean and Africa.

Main Outcome Measures Transplant rates (number of HSCTs per 10 million

inhabitants) by indication, donor type, and country; description of main

differences in HSCT use; and macroeconomic factors of reporting countries

associated with HSCT rates.

Results There were 50 417 first HSCTs; 21 516 allogeneic (43%) and 28 901

autologous (57%). The median HSCT rates varied between regions and countries

from 48.5 (range, 2.5-505.4) in the Americas, 184 (range, 0.6-488.5) in Asia,

268.9 (range, 5.7-792.1) in Europe, and 47.7 (range, 2.8-95.3) in the Eastern

Mediterranean and Africa. No HSCTs were performed in countries with less than

300 000 inhabitants, smaller than 960 km2, or having less than US $680 gross

national income per capita. Use of allogeneic or autologous HSCT, unrelated or

family donors for allogeneic HSCT, and proportions of disease indications varied

significantly between countries and regions. In linear regression analyses,

government health care expenditures (r2 = 77.33), HSCT team density (indicates

the number of transplant teams per 1 million inhabitants; r2 = 76.28), human

development index (r2 = 74.36), and gross national income per capita (r2 =

74.04) showed the highest associations with HSCT rates.

Conclusion Hematopoietic stem cell transplantation is used for a broad spectrum

of indications worldwide, but most frequently in countries with higher gross

national incomes, higher governmental health care expenditures, and higher team

densities.

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