Blood and marrow transplantation in mainland China

As of 1981, allogeneic bone marrow transplantation (allo-BMT) was applied in an acute leukaemia patient with success. Since then, the number of BMT has been increasing gradually, especially since the 1990s. Approximately 2000 BMTs per year have been performed in recent years in more than 100 BMT units in mainland China. A recent survey of 12 major BMT units indicates that the predominant types of transplantation performed are identical sibling (38.6%), related mismatched/haploidentical (19.4%), unrelated (17.2%), and autologous (24.5%). The indications of major disease entities are acute myeloid leukaemia (32.8%), acute lymphoblastic leukaemia (20%), chronic myeloid leukaemia (CML) [18.9%], and lymphoid malignancy (13.5%). The number of transplants from unrelated donor or related mismatched/haploidentical donor has been increasing significantly in recent 6 years. Granulocyte colony-stimulating factor-mobilised bone marrow plus peripheral blood are routinely used as a source of stem cells for haploidentical BMT. Umbilical cord blood is used less often. Although the total number of patients who received allo-BMT continues to increase, the increase in BMT for CML has been flattened since 2004. By the end of 2008, more than 960 000 volunteer's human leukocyte antigen (HLA) data are available in Chinese Marrow Donor Program (CMDP), and more than 1100 stem cell donations have been performed from it. Stem cells for unrelated BMT in mainland China are mainly from Taiwan Tzu Chi Stem Cell Center and CMDP. Related HLA-mismatched/haploidentical BMT has reached fairly good outcomes in terms of severe acute graft-versus-host disease (GVHD), chronic GVHD, relapse, treatment-related mortality, disease-free survival, and overall survival, which are comparable with HLA-identical-sibling BMT in the author's BMT units. Syngeneic BMT started successfully in 1964 and has still very good outcomes in more than 23 BMT units from the statistics of Chinese Society of Blood and Marrow Transplantation.