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Prepublished online as a Blood First Edition Paper on May 31, 2002; DOI 10.1182/blood-2002-03-0675.
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Blood, 1 October 2002, Vol. 100, No. 7, pp. 2374-2386
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Current trends in hematopoietic stem cell transplantation in
Europe
Alois Gratwohl,
Helen Baldomero,
Bruno Horisberger,
Caroline Schmid,
Jakob Passweg, and
Alvaro Urbano-Ispizua for the
Accreditation Committee of the European Group for Blood
and Marrow Transplantation (EBMT)
From the Division of Hematology, Department of Internal
Medicine and Department of Research, Kantonsspital Basel, Switzerland;
Research Institute for Management in Health Care (FMIG), St Gallen,
Switzerland; and EBMT Secretariat, Hospital Clinic, Barcelona, Spain.
Major changes have occurred in the transplantation of hematopoietic
stem cells (HSCs) during the last decade. This report reveals the
changes, reflects current status, and provides medium-term projections
of HSC transplantation (HSCT) development in Europe. Data on 132 963
patients, 44 165 with allogeneic HSC transplant (33%) and 88 798
with an autologous HSC transplant (67%), collected prospectively from
619 centers by the European Group for Blood and Marrow Transplantation
(EBMT) in 35 European countries between 1990 (4234 HSCTs) and 2000 (19 136 HSCTs) illustrate utilization of HSCT. HSCT increased in all
European countries and for all indications. There were major
differences depending on disease indication and donor type.
Transplantation rates (numbers of HSCTs per 10 million
inhabitants) varied from less than 1 for some rare indications to
37.7 ± 4.1 for acute myeloid leukemia in allogeneic HSCT or
95.5 ± 13.5 for non-Hodgkin lymphoma in autologous HSCT. There were
indications with a steady, continuing increase and others with initial
increase but subsequent decrease. Projections on medium-term
development for each disease based on a weighted sensitivity analysis
predict an ongoing increase in allogeneic HSCT except for chronic
myeloid leukemia. In autologous HSCT they predict an increase for
lymphoproliferative disorders, acute myeloid leukemia, myelodysplastic
syndromes, and some solid tumors but a decrease for most solid tumors,
acute lymphoid leukemia, and chronic myeloid leukemia.
Transplantation rates can be predicted with reasonable
sensitivity for most disease indications. Despite marked changes in the
rapidly developing field of HSCT, this information on current use,
trends, and midterm predictions forms a rational basis for patient
counseling and health care planning.
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