ArticlesOne million haemopoietic stem-cell transplants: a retrospective observational study
Introduction
WHO has recently recognised the broad idea of provision of medical products of human origin as an important global medical task.1 The transplantation of cells, tissues, and organs has extended the lifespan of hundreds of thousands of patients worldwide and enhanced their quality of life. As part of this success, the availability of products and procedures has decreased; expectations of patients in need have triggered organ trade and stem cell tourism. As a consequence, guidelines by WHO declare that regulation of transplantation on a national level is a governmental responsibility.1, 2, 3, 4, 5 Data collection and data analysis have been recognised as integral parts of the treatment to achieve efficient and cost-effective use of resources. Harmonised data for use and trends worldwide are a key prerequisite.6, 7 Information about how to best support introduction of HSCT and how this technique has spread remains scarce. Traditional methods of health technology assessment are likely to fail in view of the vast heterogeneity of approaches and small number of transplantation studies being done.8, 9
Haemopoietic stem-cell transplantation (HSCT) is an established but complex treatment for selected patients with severe congenital or acquired disorders of the haemopoietic system10, 11, 12 and some other life-threatening disorders. Achievements with HSCT have stimulated research in the biology, property, and functions of stem cells, and treatment of cancer generally. Novel technologies to generate, expand, and maintain stem and precursor cells create hope for custom tailored stem cells. Ideas for use range from single organ disease to trauma repair or partial organ replacement.13, 14, 15, 16 HSCT has evolved from experimental bone marrow transplantation more than half a century ago to an accepted and successful treatment; therefore, the long experience and past errors and successes might serve to improve access for all patients in need and as guidance for the application of medical products of human origin generally.
The Worldwide Network for Blood and Marrow Transplantation (WBMT), an HSCT umbrella organisation recognised by WHO as a non-governmental organisation, has taken up the task of helping with HSCT worldwide. On the occasion of the one millionth transplant at the end of 2012, we present the worldwide diffusion of HSCT from its beginning up to now.17
Section snippets
Patients and study design
In this retrospective observational survey we analysed the number of HSCTs worldwide from the first published series (to the best of our knowledge) of bone marrow transplants in 195718 to Dec 31, 2012 (table 1). Data for HSCT were collected by WBMT through its network of international or regional member organisations; data for registered unrelated donors, on registered cord blood products and on their use were collected through the World Marrow Donor Association. The organisations providing the
Results
Numbers of HSCT increased after an initial period of limited activity continually to 10 000 HSCTs worldwide by 1985, to roughly 50 000 by 1991, to about 100 000 by 1995, to roughly 500 000 by 2005, and doubled to about 1 million by December, 2012 (table 1 and figure 1A). When HSCT first started, this technique was restricted to a few countries (appendix pp 4–11). By the end of 2012, HSCT had spread slowly but steadily to 75 countries; 35 started with allogeneic HSCT, 23 with allogeneic and
Discussion
These global findings show striking differences in absolute transplant numbers, frequency of transplant, and spread of HSCT. The different patterns are affected mainly by macroeconomic factors related to availability of resources and infrastructure. We noted major differences in use of autologous and allogeneic HSCT (panel). Global numbers of allogeneic HSCT increased with no signs of saturation but substantial differences between regions were present. Of note, increase in absolute numbers was
References (46)
History of solid organ transplantation and organ donation
Crit Care Clin
(2009)The politics of combating the organ trade: lessons from the Israeli and Pakistani experience
Am J Transplant
(2013)Best practices in regulation of blood and blood products
Biologicals
(2012)- et al.
Engineered autologous cartilage tissue for nasal reconstruction after tumour resection: an observational first-in-human trial
Lancet
(2014) US company comes under fire over patent on umbilical cord cells
Nature
(1996)- et al.
Remuneration of hematopoietic stem cell donors: principles and perspective of the World Marrow Donor Association
Blood
(2011) A special report: bone marrow transplants using volunteer donors–recommendations and requirements for a standardized practice throughout the world–1994 update. The WMDA Executive Committee
Blood
(1994)- et al.
Effect of centre on outcome of bone-marrow transplantation for acute myeloid leukaemia
Lancet
(2000) Impacts of pretransplant comorbidities on allogeneic hematopoietic cell transplantation (HCT) outcomes
Biol Blood Marrow Transplant
(2009)- et al.
Globally consistent coding systems for medical products of human origin
Bull World Health Organ
(2013)
Experimental treatments: regulating stem-cell therapies worldwide
Nature
WHO guiding principles on human cell, tissue and organ transplantation
Transplantation
Challenges and opportunities for HSCT outcome registries: perspective from international HSCT registries experts
Bone Marrow Transplant
Funding the unfundable: mechanisms for managing uncertainty in decisions on the introduction of new and innovative technologies into healthcare systems
Pharmacoeconomics
Coverage options for promising technologies: Medicare's ‘coverage with evidence development’
Health Aff (Millwood)
Hematopoietic stem-cell transplantation
N Engl J Med
Allogeneic and autologous transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe 2009
Bone Marrow Transplant
2010 report from the Center for International Blood and Marrow Transplant Research (CIBMTR): current uses and outcomes of hematopoietic cell transplants for blood and bone marrow disorders
Clin Transpl
A new dawn for stem-cell therapy
N Engl J Med
The survey on cellular and engineered tissue therapies in Europe in 2011
Tissue Eng Part A
Cardiac tissue engineering: state of the art
Circ Res
Media fact sheet: 1 million blood stem cell transplants Worldwide
Aplastic anemia treated with daily transfusions and intravenous marrow; a case report
Ann Intern Med
Cited by (309)
An Analysis of the Worldwide Utilization of Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia
2023, Transplantation and Cellular TherapyThe mythological chimera and new era of relapse prediction post-transplant
2023, Blood Reviews
- †
Dr Blume died on Jan 9, 2013