Haematopoietic stem cell transplantation (HSCT) in Europe 2002. Changes in indication and impact of team density. A report of the EBMT activity survey

Abstract

Summary:This 2002 European Group for Blood and Marrow Transplantation (EBMT) activity survey concentrates on current status, increase and decrease in haematopoietic stem cell transplantation (HSCT) activity in Europe and investigates the association of transplant rates with team density. In 2002, there were 20 207 HSCT, 6915 allogeneic (34%), 13 292 autologous (66%) and 3947 additional re-or multiple transplants collected from 586 centres in 39 European countries. Main indications were leukaemias (6523 (32%; 76% allogeneic)); lymphomas (10 760 (53%; 92% autologous)); solid tumours (1913 (9%; 92% autologous)) and nonmalignant disorders (874 (4%; 92% allogeneic)). Compared to 2001, there were increases (410%) for AML, ALL 1st CR, CML not 1st cP, MDS, SAA and CLL in allogeneic HSCT and for MDS, Ewing's sarcoma, soft-tissue sarcoma and ovarian cancer in autologous HSCT. Decreases (410%) were observed in autologous HSCT for acute leukaemias beyond 1st CR, CML cP, glioma, breast cancer and lung cancer. Correlation of transplant rates (number of transplants per 10 million inhabitants) with team density (number of transplant teams per 10 million inhabitants) suggests different diffusion patterns for autologous compared to allogeneic HSCT. These data describe current practice for blood and marrow transplantation in Europe and give some hints about mechanisms involved in HSCT rates. Bone Marrow Transplantation (2004Transplantation ( ) 34, 855-875. doi:10.1038 Keywords: haematopoietic stem cell; team density; transplant rates; diffusion of technology Haematopoietic stem cell transplantation (HSCT) has seen a rapid increase and substantial change over the last decade. It is an established therapy for many severe acquired or congenital disorders of the haematopoietic system and for chemosensitive, radiosensitive or immunosensitive malignancies. Haematopoietic stem cells from bone marrow, peripheral blood or cord blood are used as the stem cell source. They are derived for autologous use from the patients themselves. Donors for allogeneic HSCT include HLA-identical siblings, other family members or unrelated volunteers from one of the increasing worldwide donor pools or cord blood banks. [1][2][3][4] There are many reasons for this increase of HSCT in Europe. It is based on increased numbers of HSCT in teams already active in 1990 5 as well as on an increase in transplant teams and an extension of transplant activity to countries with previously none or limited numbers of active transplant teams. Numbers of HSCT did not increase at the same rate for autologous and allogeneic HSCT. They did not increase for all indications alike. 6,7 Specifically, numbers of autologous HSCT for solid tumours declined after a peak in 1997 almost as rapidly as they had previously increased. They were substituted for by increasing numbers of autologous HSCT for lymphoproliferative disorders. For allogeneic HSCT, there remains a steady increase in transplants for all indications with one major exception. Numbers of transplants for CML have been d...

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