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Current trends in hematopoietic stem cell transplantation in Europe
Alois Gratwohl1, Helen Baldomero, Bruno Horisberger
1Division of Hematology, Department of Internal Medicine and Department of Research, Kantonsspital Basel, Switzerland. hematology@uhbs.ch
Insights
Hematopoietic stem cell transplantation (HSCT) has significantly increased across Europe for various diseases. Projections indicate continued growth, with specific trends for allogeneic and autologous HSCT, aiding healthcare planning.
Area of Science:
- Hematology
- Transplantation Medicine
- Oncology
Background:
- Hematopoietic stem cell transplantation (HSCT) has undergone significant evolution over the past decade.
- The European Group for Blood and Marrow Transplantation (EBMT) has collected extensive data on HSCT utilization across Europe.
Purpose of the Study:
- To analyze changes, current status, and medium-term projections of HSCT development in Europe.
- To provide data-driven insights for patient counseling and healthcare planning in HSCT.
Main Methods:
- Analysis of prospective data from 132,963 patients across 619 centers in 35 European countries (1990-2000).
- Evaluation of HSCT utilization trends by disease indication and donor type (allogeneic vs. autologous).
- Weighted sensitivity analysis for medium-term development projections for various diseases.
Main Results:
- Overall HSCT increased significantly across Europe between 1990 and 2000.
- Transplantation rates varied widely by disease indication and donor type, with notable differences for acute myeloid leukemia and non-Hodgkin lymphoma.
- Projections suggest continued allogeneic HSCT increase (except CML) and mixed trends for autologous HSCT (increase for some hematologic malignancies and solid tumors, decrease for others).
Conclusions:
- HSCT utilization has markedly increased in Europe, with distinct trends for different diseases and transplant types.
- Medium-term projections provide a rational basis for future patient counseling and healthcare resource planning.
- The data highlights the dynamic nature of HSCT and the need for ongoing monitoring and prediction.
Abstract:
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.