Hematopoietic stem cell transplantation: a global perspective

Alois Gratwohl, Helen Baldomero, Mahmoud Aljurf, Marcelo C Pasquini, Luis Fernando Bouzas, Ayami Yoshimi, Jeff Szer, Jeff Lipton, Alvin Schwendener, Michael Gratwohl, Karl Frauendorfer, Dietger Niederwieser, Mary Horowitz, Yoshihisa Kodera, Worldwide Network of Blood and Marrow Transplantation, Alois Gratwohl, Helen Baldomero, Mahmoud Aljurf, Marcelo C Pasquini, Luis Fernando Bouzas, Ayami Yoshimi, Jeff Szer, Jeff Lipton, Alvin Schwendener, Michael Gratwohl, Karl Frauendorfer, Dietger Niederwieser, Mary Horowitz, Yoshihisa Kodera, Worldwide Network of Blood and Marrow Transplantation

Abstract

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 km(2), 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 (r(2) = 77.33), HSCT team density (indicates the number of transplant teams per 1 million inhabitants; r(2) = 76.28), human development index (r(2) = 74.36), and gross national income per capita (r(2) = 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.

Conflict of interest statement

There are no conflicts of interest pertinent to this manuscript to declare.

Figures

Fig 1. Global distribution of HSCT in…
Fig 1. Global distribution of HSCT in 2006
Transplant rates (= number of HSCT per 10 million inhabitants) for all HSCT, allogeneic and autologous by continental region. Regions are colored by WHO regional offices code (see text) (www.who.int/about/regions/en/). Blue: Americas; green: Europe; magenta: Asia; yellow: EMRO/Africa
Fig 2. Relative proportion of donor type…
Fig 2. Relative proportion of donor type and main indications by continental region
Proportion of allogeneic versus autologous HSCT (left four bars) Proportion of family versus unrelated donors in allogeneic HSCT (middle four bars) Proportion of main indications for allogeneic HSCT (right four bars) Leuk = leukemia, LPD = lymphoproliferative disorders, NM = Non malignant disorders, ST = solid tumors Auto= autologous HSCT; allo = allogeneic HSCT
Fig 3. Macro-economic factors and transplant rates
Fig 3. Macro-economic factors and transplant rates
Dots represent individual countries. Country code according to the Olympic committee country code (http://www.olympia-statistik.de/ABC.htm). Colors represent regions. Blue: America; green: Europe; magenta: Asia; yellow: EMRO/Africa a Transplant rates and Governmental Health Care Expenditures b Transplant rates and team density c Transplant rates and Human Developmental Index
Fig 3. Macro-economic factors and transplant rates
Fig 3. Macro-economic factors and transplant rates
Dots represent individual countries. Country code according to the Olympic committee country code (http://www.olympia-statistik.de/ABC.htm). Colors represent regions. Blue: America; green: Europe; magenta: Asia; yellow: EMRO/Africa a Transplant rates and Governmental Health Care Expenditures b Transplant rates and team density c Transplant rates and Human Developmental Index
Fig 3. Macro-economic factors and transplant rates
Fig 3. Macro-economic factors and transplant rates
Dots represent individual countries. Country code according to the Olympic committee country code (http://www.olympia-statistik.de/ABC.htm). Colors represent regions. Blue: America; green: Europe; magenta: Asia; yellow: EMRO/Africa a Transplant rates and Governmental Health Care Expenditures b Transplant rates and team density c Transplant rates and Human Developmental Index

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Source: PubMed

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