The EBMT activity survey on hematopoietic-cell transplantation and cellular therapy 2018: CAR-T’s come into focus

Abstract

Hematopoietic-cell transplantation (HCT) is widely used for acquired and congenital disorders of the hematopoietic system. Number of transplants performed in Europe and associated countries continues to rise with 47,468 HCT in 42,901 patients [19,630 allogeneic (41%) and 27,838 autologous (59%)] reported by 701 centers in 50 countries in 2018. Main indications were myeloid malignancies 10,679 (25%; 97% allogeneic), lymphoid malignancies 27,318 (64%; 20% allogeneic), solid tumors 1625 (4%; 2.9% allogeneic), and nonmalignant disorders 3063 (7%; 81% allogeneic). This year's analysis focuses on cellular therapies with the marked growth in CAR T-cell therapies from 151 in 2017 to 301 patients reported in 2018. Other cellular therapy numbers show less significant changes. Important trends in HCT include a 49% increase in allogeneic HCT for chronic phase CML (although transplant numbers remain low) and a 24% increase in aplastic anemia. In autologous HCT, there is an ongoing increase in autoimmune diseases (by 19%), predominantly due to activity in multiple sclerosis. This annual report reflects current activity and highlights important trends, useful for health care planning.

Progress and trends in pediatric hematopoietic cell transplantation in Central-East European countries

“…When compared to 2003 and 2013 activity reports, our analysis shows a significant increase in transplant activity in the pediatric population in Central-East European countries in 2018, especially in the allo-HCT setting [2,3,7]. Compared to 2013, we observed an increase in the number of transplants due to ALL, MDS, HL, and SAA/BFM in 2018, which was also observed in other countries in respective indications [2,3]. The number of transplants due to NBL also increased, while metabolic diseases were at the same level.…”

“…This expansion is much more pronounced in allo-HCT (7.1% in 2018 when compared to 2017) setting than in the auto-HCT setting (2.4% in 2018 when compared to 2017), especially in the pediatric population (9.4% allo-HCT vs. 3.0% auto-HCT) [3]. When compared to 2003 and 2013 activity reports, our analysis shows a significant increase in transplant activity in the pediatric population in Central-East European countries in 2018, especially in the allo-HCT setting [2,3,7]. Compared to 2013, we observed an increase in the number of transplants due to ALL, MDS, HL, and SAA/BFM in 2018, which was also observed in other countries in respective indications [2,3].…”

“…This is the first report that demonstrates the development of HCT activity in Central-East European countries in the pediatric population in two-time points (2013 and 2018). The EBMT activity surveys conducted since 1990 indicate a steady increase in the number of HCT, which exceeded 47,000 transplantations per year in 2018 [3,8].…”

“…However, a significant decrease in the number of pediatric transplants was observed due to non-HL when compared to data from the 2013 and 2018 annual activity surveys in the general population [2], probably due to the development of the targeted therapy. The introduction of tyrosine kinase inhibitors has marked a revolutionary step in CML patients resulting in the low number of transplants when compared with previous activity reports [2,3,9].…”

“…According to the European Society for Blood and Marrow Transplantation (EBMT) activity survey in 2013, a record number of 39,209 HCT in 34,809 patients performed in Europe and associated countries was reported, whereas in 2018 this number raised to 47,468 HCT in 42,901 patients [2,3]. The EBMT activity survey has been conducted each year since 1990 [4], therefore, we can follow not only the increasing number of HCT every year but also the changing trends regarding the source of the stem cells, type of transplant, or indications for transplant procedures.…”