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Prepublished online as a Blood First Edition Paper on May 31, 2002; DOI 10.1182/blood-2002-03-0675.
Submitted March 5, 2002
Accepted May 15, 2002
Current Trends in Hematopoetic Stem Cell Transplantation in Europe
Alois Gratwohl*, Helen Baldomero, Bruno Horisberger, Caroline Schmid, Jakob Passweg, and Alvaro Urbano-Ispizua
Division of Hematology, Kantonsspital Basel, Basel, Switzerland
Research Institute for Management in Health Care, FMIG, St. Gallen, Switzerland
EBMT Secretariat, Hospital Clinic, Barcelona, Spain
* Corresponding author; email: hematology{at}uhbs.ch.
Major changes have occurred in the transplantation of hematopoetic stem cells (HSCT) during the last decade. This report reveals the changes, reflects current status and provides medium term projections of HSCT development in Europe. Data on 132,963 patients, 44,165 with an allogeneic HSCT (33%) and 88,798 with an autologous HSCT (67%), collected prospectively from 619 centres by the European Group for Blood and Marrow Transplantation (EBMT) in 35 European countries between 1990 (4,234 HSCT) and 2000 (19,136 HSCT) illustrate utilisation of HSCT. HSCT increased in all European countries and for all indications. There were major differences depending on disease indication and donor type. Transplant rates (numbers of HSCT per ten million inhabitants) varied from <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's 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. Transplant 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 mid-term predictions forms a rational basis for patient counselling and health care planning.
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