Study examines worldwide use of HSCT

Stem cells

A recent study looked at the world-wide usage of hematopoietic stem cell transplant (HSCT) and found significant differences in transplant rates among countries and continental regions by indication and donor type.

They also found that HSCT is used most frequently in countries with higher gross national incomes and government healthcare expenditures.

The study, carried out by Alois Gratwohl, MD, of the University Hospital Basel, Switzerland, and colleagues, is published in the April 28 issue of JAMA.

The team retrospectively analyzed 50,417 patients who received their first HSCT in 2006. Data were collected from 1,327 centers in 71 countries that participate in the Worldwide Network for Blood and Marrow Transplantation.

The researchers divided the world into four regional areas for their analysis—North and South America; Asia and the Western Pacific region, including Australia and New Zealand; Europe, including Turkey and Israel; and the Eastern Mediterranean and Africa.

Fourty-three percent of HSCTs performed in 2006 were allogeneic and 57% were autologous, most of which occurred in the Americas and Europe. In 2006, 48% of HSCTs were performed in Europe, 36% in North and South America, 14% in Asia, and 2% in the Eastern Mediterranean and Africa. Median HSCT rates per million inhabitants were 48.5 in the Americas, 184 in Asia, 268.9 in Europe, and 47.7 in the Eastern Mediterranean and Africa.

Acute myeloid leukemia was the malignant disease treated most frequently with allogeneic HSCT, accounting for 33% of allogeneic transplants performed. Bone marrow failure was the nonmalignant disease treated most frequently with allogeneic transplant, accounting for 6% of allogeneic HSCTs performed. Plasma cell disorders accounted for 41% of autologous HSCTs.

There were no HSCTs performed in countries with a population of less than 300,000 people, smaller than 960 square kilometers, or with a gross national income under US $680 per capita.

“In conclusion, this global overview on HSCT activity demonstrates that it is an accepted therapy worldwide, with different needs and priorities in different regions,” according to the research team. “Transplant activity is concentrated in countries with higher healthcare expenditures, higher gross national income per capita, and higher team density; hence, the availability of resources, governmental support, and access to a transplant center determine regional HSCT activity.”