EBMT activity survey 2004 and changes in disease indication over the past 15 years

Abstract

This fifteenth annual European Group for Blood and Marrow Transplantation activity report lists the transplant activity in Europe in 2004 and documents the changes in indication over the past 15 years. In 2004, there were 22 216 first hematopoetic stem cells (HSCT), 7407 allogeneic (33%), 14 809 autologous (67%) and 4378 additional re-or multiple transplants reported from 592 centres in 38 European and five affiliated countries. Main indications were leukemias (7045 (32%; 78% allogeneic)); lymphomas (12 310 (55%; 94% autologous)); solid tumors (1759 (8%; 93% autologous)) and nonmalignant disorders (1015 (5%; 92% allogeneic)). In comparison, 145 teams from 20 countries performed 4234 HSCT (2137 allogeneic, 50%; 2097 autologous, 50%) in 1990. The overall increase was accompanied by major changes. Stem cell source changed from bone marrow to peripheral blood. More than one-third of allogeneic HSCT are now from unrelated donors. Reduced intensity conditioning is employed for one-third of allogeneic HSCT. Leukemias for allogeneic and lymphoproliferative disorders for autologous HSCT continue to increase. The decline in HSCT for chronic myeloid leukemia appears to level off for the first time since 1999. These data are informative for patient counselling and decision making for health care professionals. Bone Marrow Transplantation (2006) 37, 1069-1085. doi:10.1038/sj.bmt.1705377 Keywords: hematopoietic stem cell transplantation; Europe; transplant rates; leukemia; solid tumor; nonmalignant diseases IntroductionTransplantation of hematopoietic stem cells (HSCT) offers a unique opportunity for long-term disease control to many patients with severe malignant or hematopoietic stem cells malignant, acquired or congenital disorders of the hematopoietic system or with chemo-radiosensitive tumors. [1][2][3] HSC has seen rapid expansion over the last decade and the increasing demand for this high-cost procedure can present a challenge for health care systems in any country. Precise information on current use and trends is essential for patients, physicians and health care providers alike. 4,5 The activity survey of the European Group for Blood and Marrow Transplantation (EBMT) was designed in 1990 to provide this information in a most efficient way and to disseminate it rapidly on an annual basis. 6 All EBMT members and affiliated teams, known to perform transplants, were requested to report their numbers of patients transplanted by indication, stem cell source and donor type on an annual basis. The initial survey sheet was slightly changed over the years, to respond to changes in indication and to collect additional generic information on the numbers of re-or multiple transplants, on the percentage of cord blood HSCT and on the percentage of transplants with reduced intensity conditioning (RIC HSCT). The EBMT survey was adopted by the General Assembly as a mandatory self-reporting system. It forms now an integral part of a comprehensive quality assurance program JACIE (Joint Accreditation Committee of the International Socie...

Full-intensity and reduced-intensity allogeneic stem cell transplantation in AML

“…1 This reflects both the continued inadequacy of conventional chemotherapy and the growing realization that a potent graft-versus-leukaemia (GVL) may be exploited in patients allografted for AML. In the past decade it has become clear that not only has the benefit of myeloablative allogeneic transplantation in younger patients been consistently underestimated but also that the use of reduced-intensity conditioning (RIC) regimens now permits the delivery of a potentially curative GVL effect in older patients whose outcome with conventional chemotherapy would be dismal.…”

A prospective evaluation of patients' health-related quality of life during auto-SCT: a 3-year follow-up

“…1,2 Use of auto-SCT, in which the patient's own stem cells are used, has increased, especially for patients with multiple myeloma (MM) and lymphoma. 1 Before the stem cell infusion, different conditioning regimens consisting of high-dose chemotherapy and/or TBI are administered. Patients undergoing auto-SCT experience a wide variety of side effects related to the treatment.…”

Leucemia mieloide crônica e outras doenças mieloproliferativas crônicas

“…O TCHP CIR apresenta um menor efeito antitumor pela quimioterapia de condicionamento e, em acompanhamento por longo período de tempo, pode haver uma maior incidência de recidiva. 51,52 Até o momento, não há evidências claras que TCHP de CIR seja melhor que TCHP mieloablativo, ou que ofereça vantagem para pacientes jovens que sejam candidatos a um TCHP. Há indicação para pacientes idosos ou jovens que não seriam candidatos a um condicionamento mieloablativo.…”

“…Os resultados são inferiores para fase acelerada e crise blástica (30%-40% e < 5%-10%, respectivamente). [52][53][54][55] Uma vez tratada a crise blástica e alcançada segunda fase crônica, ainda podem ser obtidos bons resultados utilizando o TMO alogênico. Algumas das principais séries publicadas estão resumidas na Tabela 8.…”